Postmenopausal bleeding: Causes, diagnosis & treatment

Dr Louise Hayes Dr Louise Hayes MBBS (Lond.) FRCOG, Consultant in Gynaecology & Women’s Health Published March 9th 2023

Bleeding a year or more after your last period can come as a shock, but it’s not that unusual and is generally easily treated or will go away of its own accord. But it should never be ignored. Postmenopausal bleeding, however slight, is not normal, could be serious, and must be checked out.

Why am I bleeding?

Postmenopausal bleeding – vaginal bleeding a year or more after your final period – is usually caused by vaginal dryness, polyps (noncancerous growths) or other changes in your reproductive system.

It can range from light spotting, typically pinkish-grey or brown, to a heavy flow, like a regular period. Usually painless, and often nothing more than, say, a natural bodily response to HRT, it could be a sign of something that needs dealing with, such as:

  • Endometrial or vaginal atrophy – where the uterus or vagina lining becomes thin and dry
  • Uterine polyps – small growths in the uterus
  • Uterine or endometrial cancer – cancer in the lining of the uterus
  • Cervical cancer – cancer in the cervix
  • Cervicitis or endometritis – infection or inflammation of the cervix or uterus
  • Endometrial hyperplasia – where the lining of the uterus gets too thick, and may develop abnormal cells

In some cases, it turns out the bleeding is actually coming from elsewhere, such as the bladder, the rectum, or the skin of the vulva.

In all cases, though, postmenopausal bleeding is not normal, could be a sign of something that needs immediate medical attention, and must be checked out by your doctor.

How can I find out whether it’s serious?

Your doctor or gynecologist will probably start out by asking you a load of questions, to try to get a clear picture of your medical background and current situation. Questions like:

  • When was your last period? The longer it’s been since you went through the menopause, the greater the cause for concern.
  • Are you taking any new medications? Vaginal bleeding can be a side effect of certain drugs, such as blood thinners and some mental health-related medicines.
  • How’s your health generally? Other medical conditions could be relevant.

After you’ve had this discussion, your doctor will probably want to follow up with a physical pelvic exam, perhaps pressing on and around your tummy, and inside your vagina, feeling for lumps, or tenderness, or anything else that doesn’t seem quite right.

From this point on, next steps will depend on factors including your age, how long it’s been since your last period, and the extent of your bleeding. You may need further tests, such as:

  • Vaginal ultrasound scan – in which a small device is placed in your vagina to scan for any problems
  • Hysteroscopy – a thin, telescope-like camera is passed up your vagina, through the cervix and into your womb to look for any issues
  • Biopsy – in which small tissue samples from the lining of your uterus are removed for testing

How will my bleeding be treated?

Your treatment will depend on the outcome from your discussion and any tests you’ve had. It may be anything from ‘wait and see’ to an immediate operation, but is most likely to fall under one of two broad headings: medication, and surgery.

Medications include:

  • Antibiotics – used to treat most infections of the cervix or uterus
  • Oestrogen – which can alleviate bleeding due to vaginal dryness, applied either vaginally, using a cream, ring, or insertable tablet, or systemically, with pills or patches to spread the hormone throughout your body
  • Progestin – a synthetic form of the hormone progesterone, delivered via pill, injection, cream, or IUD, which treats endometrial hyperplasia by triggering the uterus to shed its lining

Surgeries include:

  • Hysteroscopic surgery – with a camera diagnosis followed up by surgical removal – usually under general anaesthesia – of polyps or other abnormal growths.
  • Dilation and curettage (D&C) – a procedure to sample the lining and contents of the uterus, used to treat some types of endometrial hyperplasia. Often a follow-up to a hysteroscopy.
  • Hysterectomy – surgery to remove your uterus and cervix if you have uterine cancer. Approaches differ, depending on your situation, but may involve minimal cuts and few if any after effects.

Is there anything I can do to avoid postmenopausal bleeding?

The most important thing you can do is look after yourself and be aware of your body.

Some cases of postmenopausal bleeding can be little more serious than a nose bleed. But some could be early signs of cancer, or of underlying conditions that, without prompt treatment, could head that way.

It’s a good idea to visit your gynaecologist regularly for screenings. It’s all about early detection. Small interventions now can save a lot of grief further down the line.

Eat well, exercise regularly, even if it’s just a walk in the park. This alone can prevent a whole range of complications and conditions throughout your body – and mind. Try to maintain a healthy weight.

Consider hormone replacement therapy. It has pros and cons, but one important pro is potential prevention of endometrial cancer. Your gynaecologist or doctor will discuss your options – with pros and cons thoroughly explored.

A number of different conditions could result in postmenopausal bleeding. Most cause no great discomfort or damage, and have no long term effects. But some are serious, so postmenopausal bleeding should always be properly checked out.

Yes. Most postmenopausal bleeding ends up requiring little if any treatment and has no long term effects. But it can be a sign of a serious underlying condition, such as cancer. In which case, the earlier it’s diagnosed and dealt with, the better. Always seek qualified advice straightaway.

Many cases of postmenopausal bleeding require no treatment, other than looking after yourself and keeping warm, but depending on the underlying cause you may need over-the-counter or prescription drugs, or surgery.

It can be. Which is why it’s vital to get checked out if you bleed more than a year after your last period – even very slightly.

Rarely, but it can, depending on the underlying cause. If you have any concerns, speak to your doctor or gynaecologist.

Meeting with a professional is always recommended when concerned.

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