About post-menopausal bleeding

By Miss Louise Hayes MBBS (Lond.) FRCOG
Consultant in Gynaecology & Women’s Health
First published March 2023

Postmenopausal bleeding is vaginal bleeding that occurs a year or more after your last menstrual period. It can be a symptom of vaginal dryness, polyps (noncancerous growths) or changes in your reproductive system. In about 10% of women, bleeding after menopause is a sign of uterine cancer.

What is postmenopausal bleeding?

Postmenopausal bleeding is bleeding that occurs after menopause. Bleeding can be light (spotting) or heavy and happens around the early 50’s when a woman’s reproductive hormones drop and her monthly menstrual periods stop. It’s not normal if vaginal bleeding occurs more than a year after a woman’s last period.

Postmenopausal bleeding is usually due to non-cancerous gynaecological conditions such as endometrial polyps.

However, for about 10% of women, bleeding after menopause is a sign of uterine or endometrial cancer. Uterine cancer is the most common type of reproductive cancer It’s more common than ovarian or cervical cancer.

If you experience any bleeding after menopause and would like to arrange a consultation with Miss Hayes please click here or call her PA on +44 (0) 20 7402 2888.

Who can have postmenopausal bleeding?

Anyone can have vaginal bleeding, especially during the time leading up to menopause, This usually occurs between ages 40 and 50. It’s the time when a woman’s hormone levels and her periods start to change.

How common is postmenopausal bleeding?

Postmenopausal bleeding occurs in about 10% of women over 55 years old.

What causes postmenopausal bleeding?

The most common causes of bleeding or spotting after menopause include:

  • Endometrial or vaginal atrophy. When the lining of the uterus or vagina becomes thin and dry.
  • Hormone replacement therapy (HRT) (Oestrogen and progesterone supplements that reduce some menopausal symptoms).
  • Uterine cancer or endometrial cancer
  • Endometrial hyperplasia (the lining of the uterus gets too thick and can contain abnormal cells).
  • Uterine polyps (growths in the uterus).

Other causes of bleeding can include:

  • Cervical cancer (cancer in the cervix).
  • Cervicitis or endometritis (infection or inflammation in the cervix or uterus).
  • Bleeding from other areas, nearby, in the bladder or rectum or bleeding from the skin of the vulva (outside near the vagina).

How to identify the cause of postmenopausal bleeding

  • Arranging for a Gynaecologist to examine your vagina and cervix.
  • Pap smear to check the cervical cells.
  • A transvaginal ultrasound to look for any uterine polyps.
  • Biopsy of the endometrium or uterus. In this procedure, your Gynaecologist gently slides a thin tube into your uterus to collect cells to check if they’re abnormal.

If you experience any bleeding after menopause and would like to arrange a consultation with Miss Hayes please click here or call her PA on +44 (0) 20 7402 2888.

What’s the treatment for postmenopausal bleeding?

The treatment for postmenopausal bleeding depends on the exact cause. Medication and surgery are the most common treatments.

Medication for postmenopausal bleeding:

  • Antibiotics can treat most infections of the cervix or uterus.
  • Estrogen may help bleeding due to vaginal dryness. Estrogen can be applied directly to your vagina as a cream, a ring or insertable tablet. Estrogen therapy may come as a pill or patch.
  • Progestin is a synthetic version of the hormone progesterone. It treats endometrial hyperplasia by triggering the uterus to shed its lining. You can receive progestin as a pill, shot, cream or intrauterine device (IUD).

Surgery for postmenopausal bleeding:

  • Hysteroscopy is a procedure to examine your cervix and uterus with a camera. Your Gynaecologist inserts a hysteroscope (thin, lighted tube) into your vagina to remove polyps or other abnormal growths that may be causing bleeding. This can be done in the clinic. To remove growths, hysteroscopy is usually done in the operating theatre under general anesthetic.
  • Dilation and curettage (D&C) is a procedure to sample the lining and contents of the uterus. Your healthcare provider may perform a D&C with a hysteroscopy. A D&C can treat some types of endometrial hyperplasia.
  • Hysterectomy is a surgery to remove your uterus and cervix. You may need a hysterectomy if you have uterine cancer. Your Gynaecologist can discuss the different procedures for uterus removal. Some procedures are minimally invasive, so they use very small cuts (incisions).

When should I contact a Gynaecologist?

If you experience vaginal bleeding:

  • More than a year after your last menstrual period.
  • More than a year after starting hormone replacement therapy (HRT).

If you experience any bleeding after menopause and would like to arrange a consultation with Miss Hayes please click here or call her PA on +44 (0) 20 7402 2888.

Miss Louise Hayes is a highly respected Consultant Gynaecologist who offers her patients a range of gynaecological services and expertise at her clinic based at London’s Portland Hospital. Her expertise includes management of gynaecological conditions, menopause, fertility check-ups, and sexual health screenings.