Postmenopausal bleeding is any vaginal bleeding that occurs after you have gone through the menopause.
It can include anything from a small amount of spotting to heavier bleeding, as well as pink, red or brown vaginal discharge.
Although postmenopausal bleeding is not usually caused by something serious, it should always be investigated. In some cases, it can be a symptom of a condition affecting the womb, cervix or vagina, including womb cancer. Investigating the cause promptly means that, if there is a significant underlying condition, it can be identified and treated as early as possible.
At Gynae Solution, we understand that experiencing bleeding after the menopause can be worrying. Mr Jafaru Abu will take the time to understand your symptoms, arrange appropriate investigations and explain the results and treatment options clearly.
What Is Postmenopausal Bleeding?
Menopause is generally considered to have occurred when you have not had a period for 12 consecutive months.
Once you have gone through the menopause, your periods should stop. Therefore, any vaginal bleeding after this point is considered postmenopausal bleeding, even if:
- It only happens once
- There is only a tiny amount of blood
- You only notice spotting when wiping
- The discharge is pink or brown
- You have no pain or other symptoms
- You are unsure whether the discharge contains blood
You should not wait to see whether the bleeding happens again before seeking medical advice. The NHS recommends that any postmenopausal bleeding is assessed by a GP.
If you are taking hormone replacement therapy (HRT), some bleeding can occur depending on the type of HRT and when you started or changed treatment. However, persistent or unexpected bleeding should still be discussed with your doctor.
Symptoms of Postmenopausal Bleeding
The main symptom is, of course, vaginal bleeding after menopause.
This may present as:
- Light vaginal spotting
- Pink discharge
- Brown or blood-stained discharge
- Bright red bleeding
- Heavier vaginal bleeding
- Bleeding after sexual intercourse
- Bleeding that occurs once
- Repeated episodes of bleeding
You may or may not have other symptoms.
Some women experience pelvic discomfort, vaginal dryness or pain during sex, while others have no symptoms apart from the bleeding itself.
You should not wait for other symptoms to develop before seeking medical advice.
What Causes Postmenopausal Bleeding?
There are a number of possible causes of postmenopausal bleeding, and most are not cancer.
Vaginal or Endometrial Atrophy
One of the most common causes is thinning of the vaginal or womb lining as a result of lower oestrogen levels following the menopause.
The tissues can become thinner, drier and more fragile, meaning that they may bleed more easily.
This can sometimes cause bleeding after sexual intercourse and may be accompanied by vaginal dryness, irritation or discomfort.
Polyps
Polyps are small growths that can develop on the cervix or within the womb.
Most polyps are non-cancerous, but they can cause unexpected bleeding.
If a polyp is identified, it may be recommended that it is removed and sent for laboratory analysis.
Thickened Womb Lining
The lining of the womb is called the endometrium.
Sometimes the endometrium can become thicker than expected. This is known as endometrial hyperplasia.
Some forms of endometrial hyperplasia are harmless, while others can increase the risk of developing womb cancer and therefore require treatment or monitoring.
Hormone Replacement Therapy
HRT can sometimes cause unexpected bleeding or spotting, particularly when treatment is started or changed.
The type of HRT you take, how long you have been taking it and the pattern of your bleeding will all be considered when deciding whether further investigation is needed.
Unexpected or persistent bleeding should not simply be assumed to be a side effect of HRT.
Cervical Conditions
Changes affecting the cervix can sometimes cause bleeding, including cervical polyps, inflammation or abnormal cervical cells.
Vaginal Conditions
Changes to the vaginal tissues following the menopause can make them more fragile and susceptible to irritation or minor trauma.
In less common circumstances, abnormalities affecting the vagina can also cause bleeding.
Cancer
Although most postmenopausal bleeding is caused by something other than cancer, it can sometimes be an early symptom of endometrial (womb) cancer.
Less commonly, cancers affecting the cervix, vagina or ovaries can also be associated with postmenopausal bleeding.
This is why investigating postmenopausal bleeding is so important.
Having postmenopausal bleeding does not mean that you have cancer. The purpose of investigation is to establish the cause and make sure that any significant abnormality is identified.
When Should I See a Doctor?
You should contact your GP if you experience any vaginal bleeding after the menopause.
This applies even if:
- The bleeding is very light
- It happens only once
- You have no pain
- You have no other symptoms
- You only notice pink or brown discharge
- You are taking HRT
- You think the bleeding may simply be due to vaginal dryness
The NHS specifically advises women to seek medical advice for any postmenopausal bleeding, even when it is only spotting or occurs once.
Your GP will usually arrange appropriate assessment and, where necessary, referral to a gynaecology or postmenopausal bleeding service.
How Is Postmenopausal Bleeding Diagnosed?
The first step is understanding your symptoms and medical history.
Mr Abu may ask about:
- When you last had a period
- When the bleeding started
- How much bleeding you have experienced
- Whether it has happened more than once
- The colour of the blood or discharge
- Whether bleeding occurs after sex
- Any pelvic or abdominal pain
- Vaginal dryness or discomfort
- Your HRT history
- Any previous gynaecological conditions
- Previous cervical screening results
- Previous gynaecological surgery or treatment
- Any other symptoms you may have noticed
You may also be asked about medications and your general health.
Pelvic Examination
A pelvic examination may be recommended to assess the vagina and cervix.
A speculum examination allows the doctor to see the cervix and vaginal walls and look for possible causes of bleeding such as polyps, irritation, inflammation or visible abnormalities.
Your doctor may also carry out a pelvic examination to check for tenderness or any unusual masses.
Transvaginal Ultrasound
A transvaginal ultrasound scan is commonly used when investigating postmenopausal bleeding.
A small ultrasound probe is gently inserted into the vagina to produce detailed images of the pelvis.
The scan can assess:
- The thickness of the womb lining
- The appearance of the womb
- The ovaries
- The presence of fibroids or polyps
- Any other abnormalities within the pelvis
Ultrasound is an important part of the assessment because the appearance and thickness of the endometrium can help determine whether further investigation is required.
Hysteroscopy
If further investigation is required, you may be offered a hysteroscopy.
This involves passing a thin camera through the vagina and cervix into the womb.
It allows the specialist to look directly at the lining of the womb and identify abnormalities such as polyps or areas of thickened or unusual tissue.
A biopsy may also be taken during the procedure.
A hysteroscopy can sometimes be performed under local anaesthetic, although some women may require or prefer a general anaesthetic depending on the circumstances and procedure planned.
Endometrial Biopsy
An endometrial biopsy involves taking a small sample of tissue from the lining of the womb.
The sample is sent to a laboratory where it can be examined under a microscope.
This can help determine whether there are abnormal, precancerous or cancerous cells within the endometrium.
Not every woman with postmenopausal bleeding will need a biopsy. The decision will depend on your symptoms, examination and scan findings.
How Is Postmenopausal Bleeding Treated?
Treatment depends entirely on the underlying cause.
There is no single treatment for postmenopausal bleeding because it is a symptom rather than a condition in itself.
Vaginal Atrophy
If the bleeding is caused by thinning and dryness of the vaginal tissues, treatment may not always be necessary.
Where symptoms are troublesome, your doctor may discuss vaginal oestrogen or other treatments to improve the health and moisture of the vaginal tissues.
Polyps
If a cervical or uterine polyp is responsible for the bleeding, it may be removed.
The tissue can then be examined to confirm its nature.
Endometrial Hyperplasia
Treatment for endometrial hyperplasia depends on the type of hyperplasia and the risk of it developing into cancer.
Treatment can include hormonal medication or, in some circumstances, surgery.
Bleeding Associated With HRT
If your bleeding is related to HRT, your treatment may need to be reviewed or adjusted.
Your doctor will consider the type of HRT you are taking, how long you have been taking it and the pattern of bleeding before deciding whether further investigation is required.
Treatment for Cancer
If investigations identify cancer, you will be referred to an appropriate specialist cancer team.
Treatment will depend on the type and stage of cancer and may include surgery, radiotherapy, chemotherapy, hormone therapy or a combination of treatments.
Postmenopausal Bleeding and Womb Cancer
It is understandable to feel concerned about cancer when you experience bleeding after the menopause.
Postmenopausal bleeding is one of the symptoms that can be associated with endometrial cancer, which affects the lining of the womb.
However, most women who experience postmenopausal bleeding will not have cancer. The reason doctors investigate the symptom is because identifying cancer at an earlier stage can make treatment more straightforward and improve outcomes.
A previous normal smear test also does not rule out womb cancer. Cervical screening is designed to identify HPV and abnormal cervical cells; it is not a test for cancer of the womb lining.
For this reason, postmenopausal bleeding should always be assessed on its own merits.
Recovery and Aftercare
Your recovery will depend on the cause of your bleeding and any treatment or investigation you undergo.
If no significant abnormality is identified, you may simply be reassured or offered treatment for symptoms such as vaginal dryness.
Following a hysteroscopy or biopsy, you may experience some mild cramping or light vaginal bleeding for a short period. You will be given advice about what to expect and when to seek further medical advice.
If a condition such as a polyp or endometrial hyperplasia is identified, your specialist will explain whether further treatment or follow-up is required.
If cancer is diagnosed, your ongoing care will be coordinated with the appropriate specialist team.
Risks and Benefits of Investigation and Treatment
Investigating postmenopausal bleeding provides an important opportunity to identify the cause of the bleeding and, where necessary, begin treatment promptly.
The benefits of investigation include:
- Identifying the cause of the bleeding
- Reassuring you where no serious cause is found
- Detecting abnormal or precancerous changes
- Identifying womb or other gynaecological cancers at an earlier stage
- Allowing appropriate treatment to begin
Most investigations are straightforward, although examinations and procedures can sometimes cause temporary discomfort, cramping or light bleeding.
A hysteroscopy or biopsy also carries small risks such as infection or bleeding. More extensive treatment or surgery has additional risks, which will be explained before you make a decision about your care.
Mr Abu will discuss the purpose of each investigation with you and explain what the results could mean.
Specialist Care for Postmenopausal Bleeding
Experiencing bleeding after the menopause can understandably be worrying, particularly when you do not know what has caused it.
The important thing to remember is that postmenopausal bleeding has many possible causes, and most are not cancerous.
However, it should never simply be ignored.
At Gynae Solution, Mr Jafaru Abu will take the time to listen to your concerns, review your symptoms and arrange the appropriate investigations. Whether your bleeding is caused by vaginal changes following the menopause, a polyp, HRT, endometrial hyperplasia or another condition, the aim is to establish the cause and ensure you receive appropriate care.
If you have experienced any vaginal bleeding after the menopause, contact Gynae Solution to arrange a consultation with Mr Jafaru Abu.
Common questions
How soon can I be seen?
Daily appointments are available at The Park Hospital. Call the secretary on 0115 966 2049, or send an enquiry below and we will reply within 24 hours on business days.
Do I need a GP referral?
Referrals from GPs are welcome, and you can also enquire directly. If you are using private medical insurance, check with your insurer whether a referral is required for your policy. See GP referrals and fees and insurance.
What does a consultation cost?
A new consultation is £250 and a follow-up consultation is £150. The cost of any tests, procedures or surgery is quoted individually after your consultation. See fees and insurance.
Enquiries
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