Bleeding after menopause

Menopause is the time after you have your last period. Because your final periods can be irregular, menopause is confirmed 12 months after your last period. Bleeding or spotting after this point is called postmenopausal bleeding (PMB).

Postmenopausal bleeding needs to be checked out by a doctor. Mostly the cause will be something very simple and treatable but occasionally it is a sign of more serious disease.

It is not normal to bleed or spot 12 months or more after your last period.

Bleeding after menopause is usually a sign of a minor health problem but can sometimes be an early sign of more serious disease.

When detected early, most conditions causing bleeding after menopause (including cancer) can be successfully treated.

What causes bleeding after menopause?

Bleeding after menopause is rarely cause for concern. It does need to be investigated, however, because in very few cases it will be an indicator of something more serious. 

In about 90 per cent of cases, a particular cause for bleeding after menopause will not be found. This is not a cause for alarm, if there is a serious problem it will be identified through investigations. Most of the time, postmenopausal bleeding is caused by:

• inflammation and thinning of the lining of your vagina (called atrophic vaginitis)
• thinning of the lining of your uterus
• growths in the cervix or uterus (called polyps) which are usually not cancerous
• thickened endometrium (called endometrial hyperplasia) often because of hormone replacement therapy (HRT)
• abnormalities in the cervix or uterus.

These are generally not serious problems and can be cured relatively easily.

However, about 10 per cent of the time, post-menopausal bleeding is linked to cancer of the cervix or uterus and so it is very important to have it investigated.

Treating post menopause bleeding

If you have postmenopausal bleeding it is important to have it investigated.

You will most likely be referred to a gynaecologist who may:

• ask you questions about the history of your health
• examine you
• do a blood test
• look at the inside of your vagina and cervix using special tongs (called a speculum). At the same time, they may take a tiny sample of your cervix for testing (called a cervical screening test).

The kind of treatment you have will depend on what is causing the bleeding.

• Atrophic vaginitis and thinning of the endometrium are usually treated with drugs that work like the hormone oestrogen. These can come as a tablet, vaginal gel or creams, skin patches, or a soft flexible ring which is put inside your vagina and slowly releases the medication.
• Polyps are usually removed with surgery. Depending on their size and location, they may be removed in a day clinic using a local anaesthetic or you may need to go to hospital to have a general anaesthetic.
• Thickening of the endometrium is usually treated with medications that work like the hormone progesterone and/or surgery to remove the thickening.

Before treatment there are a number of tests and investigations your gynaecologist may recommend.

• An ultrasound of your pelvis to get a picture of your cervix, uterus, endometrium and ovaries. An external ultrasound is a small hand held device (called a transducer) that the doctor will move over you belly. An internal ultrasound is a small wand that the doctor inserts into your vagina to get a better image of your cervix and uterus.
• A pipelle test to take and test a sample or biopsy of your endometrium. This can be done without anaesthetic in a day clinic with a thin tube (or pipelle) which is put into your uterus (through your vagina) and gently sucks up a small sample of cells.
• A hysteroscopy to take photos of your cervix, uterus and endometrium. A sample or biopsy of your endometrium may also be taken for testing.  A hysteroscopy involves putting a long, narrow instrument (called a hysteroscope) into your uterus through your vagina.  It can be done under local or general anaesthetic.
• A dilation and curette (D&C) to scrape away part of your endometrium and test it. This is done under a general anaesthetic.

All treatments should be discussed with you so that you know why a particular treatment or test is being done over another.

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