Postmenopausal Bleeding – Frequently Asked Questions

14 January 2021    by - Dr Pandelis Athanasias

Menopause is when a woman stops having periods, typically occurring between age 50 and 52. It happens as a result of the depletion of oestrogen levels and is diagnosed when a woman has not menstruated for a year.

If you have already been through the menopause, then you should no longer experience bleeding from the vagina. If you do, you should consult your GP, as postmenopausal bleeding can be a sign of an underlying problem.

Continue reading as we answer some of the most common questions regarding postmenopausal bleeding.

Is postmenopausal bleeding normal?

No, vaginal bleeding after the menopause is not normal and should always be assessed by a doctor. Although postmenopausal bleeding is not always a sign of something serious (i.e. cancer) and can be caused by several different issues, it is vital to find out what the underlying cause is and seek treatment when necessary.

What causes postmenopausal bleeding?

There can be several possible causes of postmenopausal bleeding – we will explain the most common causes in detail.

Polyps – These are tissue growths that develop inside the uterus or the cervical canal and are usually non-cancerous. They can, however, cause heavy and irregular bleeding, bleeding after sexual intercourse, or spotting.

Endometrial hyperplasia – This is the thickening of the lining of the uterus. It is caused by oestrogen stimulation of the endometrium. Risk factors include taking HRT or Tamoxifen, late menopause, diabetes, nulliparity, increased weight etc. The uterine lining grows thicker and then bleeds. In some cases the abnormal cells found in the endometrium, can lead to cancer in the future, so it is essential to visit your GP when you notice any sort of postmenopausal bleeding.

Vaginal atrophy – This is the thinning and drying of the vaginal walls and is a common problem affecting around 1 in 3 women after menopause when oestrogen levels are low. It can cause pain and/or bleeding during and after sex and is a recognised factor of recurrent bladder infections.

Cancer – Bleeding is the most common sign of uterine or endometrial cancer following the menopause. It may also be a sign of vaginal or cervical cancer.

Sexually transmitted infections – In some cases, people will experience bleeding when they have an STD such as chlamydia, gonorrhoea, or herpes.

How are these conditions diagnosed?

To discover the underlying cause of your bleeding, your GP may carry out a physical examination or refer you to a specialist. You may need to undergo some tests/examinations. These include:

  • Abdominal and vaginal exam – Your doctor might press down on your stomach and the inside of your vagina, looking for tenderness or lumps
  • Pelvic exam – A speculum is inserted into the vagina to keep it open (the same as when you go for a cervical screening test) and an assessment of the vagina and cervix is performed
  • Vaginal ultrasound – A small device will be placed inside the vagina to internally scan and discover any issues
  • Hysteroscopy – A hysteroscope (a thin telescope with a light and camera attached) is passed through the vagina and cervix to examine the uterus and discover any problems. A biopsy (tissue sample) will also be collected and sent to a laboratory for testing. This procedure is carried out under either local or general anaesthetic.

What are the treatment options for postmenopausal bleeding?

The treatment offered will depend on the cause of the bleeding. For those with polyps, removal of the growths will need to be carried out by a specialist. Our Consultants are experts in removing those polyps under local anaesthetic.

Depending on the severity and type of endometrial hyperplasia, patients will either require hormone medications (progesterone) or a hysterectomy.

There are many different vaginal atrophy treatment options, including topical oestrogen, hormone replacement therapy (HRT) and new, laser treatment therapies. If HRT is causing the bleeding, your GP may recommend you change your treatment or stop altogether.

Patients who have been tested and diagnosed with a sexually transmitted infection will be given antibiotics or other medications depending on the type of infection.

I have postmenopausal bleeding – do I need to see a doctor?

Yes, you should always visit your GP or make an appointment with a gynaecologist if you notice any postmenopausal bleeding, even if it has only happened on one occasion. This includes minor spotting or brown/pinkish discharge.

At London Women’s Centre, we are specialists in women’s health problems, including postmenopausal problems and abnormal bleeding. To discuss your symptoms in confidence, book a consultation with us today.

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