What is postmenopausal bleeding?

This is vaginal bleeding which occurs more than twelve months after a woman’s last period after she has reached the menopause.  Unexpected bleeding in women who are taking hormone replacement therapy (HRT) should also be considered as post-menopausal bleeding.

What are the causes of post-menopausal bleeding?

There are many causes and most of them are not serious.  They include;

  • A delayed period, which can occur up to 2 years after the last normal period.
  • Thinning (atrophy) of the lining of the vagina and womb, common after the menopause.
  • Polyps which are small growths, are usually benign (non-cancerous) and found on the cervix (neck of the womb) or inside the womb. They are fairly common after the menopause.
  • A small number of women with post-menopausal bleeding have a more serious problem, such as cancer of the womb (uterus). For this reason it is advised that all women who have post-menopausal bleeding must see their doctor. The doctor will perform an examination and arrange certain tests and should refer the woman to a specialist clinic straightaway.

What are the tests needed to investigate post-menopausal bleeding?

An ultrasound scan. This is often carried out using a vaginal probe, most women find this test more comfortable than a smear test.

A biopsy of the lining of the womb (endometrium). This can be done in the clinic and involves a passing a thin tube through the cervix (neck of the womb) to take a sample.

A hysteroscopyis sometimes necessary to look inside the womb using a thin telescope. This can usually be done without the need for an anaesthetic.

What treatment may be required for post-menopausal bleeding?

Often no treatment is necessary but if it is, it is usually simple. If a procedure is required e.g. removal of polyps, it may be possible to do this in the clinic. A very small number of women with post-menopausal bleeding will require a major operation such as a hysterectomy (removal of the womb).