Post-menopausal bleeding

Post-menopausal bleeding is the term doctors use if you bleed again twelve or more months after your last period, and if your bleeding pattern alters more than twelve months after starting HRT.

Why are you bleeding?

Post-menopausal bleeding is pretty common, and isn’t likely to be caused by a serious condition. The most probable causes for this unexpected bleeding include:

Atrophy – when the lining of your womb and/or vagina becomes thin, and possibly inflamed too. This thinning happens because your ovaries produce much smaller amounts of the hormone oestrogen after the menopause. As a result your womb and vagina can become quite sore, and can bleed.

This condition can be treated with an oestrogen cream or pessary (tablet),  applied to or placed in the vagina. These can help restore your oestrogen levels.

Thickening of the womb lining. This can happen when you take HRT, or have high levels of oestrogen. It can also happen if you are very overweight. This is because fat cells can turn certain hormones into a form of oestrogen.

In general terms this means that the more body fat you have, the more womb lining – endometrial cells – are created. And the more of these you have, the higher the risk of developing endometrial cancer.

Cervical or womb polyps. These small growths can appear in your womb or cervix and cause bleeding. Your gynaecologist should be able to remove these at your clinic appointment, or during a small operation.

Only about one in 10 cases of post-menopausal bleeding are due to womb, cervical, vaginal or other cancer –which means that 90% of cases aren’t, which is good news. But it’s still important to see your GP and find out what’s going on. If it isn’t cancer, it will put your mind at rest. If it is, you can be treated. Often the thought of these examinations can put us off seeing our doctor, but it is really important to. If left, the condition causing the bleeding could become worse.

When you have seen your GP for an initial diagnosis they will probably refer you to a local hospital where you can give a specialist nurse or doctor information about your symptoms. They will examine you, and carry out tests, and treatment if necessary. In some areas there are specialist PMB (post-menopausal bleeding) clinics.

Tests for causes of post-menopausal bleeding

The tests you need will vary depending on the information you’ve given to your specialist. You may have a vaginal ultrasound scan, where a probe is gently put into your vagina, and using sound waves, sends a ‘picture’ of your vagina and womb to a nearby screen. This allows your specialist to see if there is anything unusual happening that needs more investigation.

You may also need a pelvic exam. Like the regular cervical screening tests you should have had in the past, this allows your nurse or doctor to do a swab test that can be checked later for infection. They can also carry out a cervical screening test if you haven’t had one for a while.

Your specialist may also need to carry out a hysteroscopy. To do this they pass the hysteroscope through your cervix, and collect a small piece of tissue from the lining of your womb, which can then be tested. You can usually have a local or a general anaesthetic for this procedure. Talk to your doctor about which choice would be best for you.

Treatment for post-menopausal bleeding

The treatment you have to deal with post-menopausal bleeding will depend on what’s causing it.  If the bleeding is being caused by polyps in your cervix or womb, your doctor can remove them. They do this by using polyp forceps to hold the base of the polyp and twist. If you have bleeding afterwards your doctor can apply some silver nitrate or heat to stop the blood flow.

If you have endometrial atrophy your doctor may give you oestrogen cream or oestrogen pessaries. And, if you are taking HRT and your specialist thinks this is linked to the bleeding, they may suggest a different type of HRT, or coming off HRT altogether.

If the results of your tests show that you have cancer, your medical team will talk to you about the best course of treatment.