Bleeding after menopause

Bleeding after menopause is called postmenopausal bleeding. It is relatively common. The bleeding can range from spotting (a pink or brown discharge) to heavier period-like bleeding. Treatment depends on the cause of the bleeding.

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Causes of postmenopausal bleeding

The cause is usually something simple and treatable. But occasionally it can be more serious. If you start bleeding after menopause, always see your healthcare provider.

Common causes of postmenopausal bleeding include:

  • the walls of your vagina or the lining of your uterus have become thinner and inflamed (vaginal atrophy)
  • the wall of your uterus (endometrium) has become thicker, often due to menopausal hormonal therapy (MHT)
  • cervical polyps.
About 1 in every 10 cases of bleeding after menopause is caused by cancer of the uterus or cervical cancer.

Symptoms of postmenopausal bleeding

Symptoms can range from spotting (a pink or brown discharge) to heavier period-like bleeding.

Diagnosing postmenopausal bleeding

Your healthcare provider will ask you about your bleeding and do a pelvic examination. They may look at your cervix using an instrument called a speculum, which they put inside your vagina.

If your last cervical screening test was more than 3 months ago they may do another one.

Tests to find out why you are bleeding may include a transvaginal ultrasound scan. This uses a specially designed ultrasound probe the width of a tampon. It is put into the lower part of your vagina to get images of your womb and check how thick the wall lining is.

Other tests you might need include a pipelle biopsy and hysteroscopy.

Treating postmenopausal bleeding

The treatment will depend on what is causing the bleeding.

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The polyps may need to be removed by a specialist.

You may not need treatment but may be offered oestrogen cream or pessaries.

Depending on the type of hyperplasia, you may be offered:

  • no treatment
  • hormone medicine (tablets or an intrauterine system, IUS)
  • total hysterectomy (surgery to remove your uterus, cervix and ovaries).

Changing or stopping MHT treatment.

Total hysterectomy will often be recommended, often followed by:

  • radiotherapy
  • chemotherapy
  • or hormone therapy
  • or a combination of treatments.

Surgery to remove your ovaries, and sometimes your uterus (total hysterectomy). You may also have chemotherapy.