Introduction: Vaginal bleeding due to leech bites is a highly unusual and serious problem in postmenopausal women, potentially leading to severe complications and even death. Case Presentation: A 68-year-old rural woman, 13 years post-menopause, was admitted to a hospital in eastern Iran with a complaint of continuous vaginal bleeding with clot discharge for 12 days. During the medical examination, a dark worm moving in waves was observed in the labia minora of the vulva. The area was washed with 0.9% normal saline solution, and the leech was removed from the inner surface of the labia minora using forceps and pincers. The patient was monitored as an outpatient for 4 hours to control the bleeding and was subsequently discharged in good condition. She was advised to take iron tablets and folic acid for one month.Her test results were as follows: Hemoglobin = 10 mg/dL, hematocrit = 32%, platelet count = 145,000, prothrombin time = 13 seconds, partial thromboplastin time = 35 seconds, and INR = 1.1. Her vital signs at admission were: temperature = 37.5°C, pulse rate = 100/min, blood pressure = 120/60 mmHg, and respiratory rate = 30 breaths per minute. Conclusions: Vulvar and vaginal leech bites can cause severe vaginal bleeding and anemia in postmenopausal women. To reduce complications caused by delays in diagnosis or treatment, healthcare workers should consider the possibility of vulvar and vaginal leech bites in postmenopausal rural women and individuals who use river water for drinking, bathing, or showering. Taking a detailed history and performing a thorough physical examination before any diagnostic procedure can help quickly and accurately diagnose the cause of bleeding in these patients.