Overview

Menopause is usually diagnosed in women over 45 who have not  had a period for more than a year. Any bleeding from the vagina after this time needs to be checked by a GP.

See a GP if:

You have postmenopausal bleeding, even if:

• it's only happened once
• there's a small amount of blood, spotting, or pink or brown discharge
• you don't have any other symptoms
• you're not sure if it's blood

Postmenopausal bleeding isn't usually serious, but can be a sign of cancer. Cancer is easier to treat if it's found early.

What happens at your GP appointment

If you have postmenopausal bleeding, a GP should refer you to hospital or a special postmenopausal bleeding clinic.

You should not have to wait more than 2 weeks to see a specialist.

What happens at your hospital or clinic appointment

A specialist, who may be a nurse, will offer you tests to help find out what's causing the bleeding and plan any necessary treatment.

The tests may include:

• a small device being placed in your vagina to scan for any problems (vaginal ultrasound scan)
• an examination of your pelvis and vagina - a speculum (plastic device) may be inserted into your vagina to hold it open, so the inside of the vagina and the cervix can be seen
• a thin, telescope-like camera being passed up your vagina and into your womb to look for any problems (a hysteroscopy) and to take a tissue sample (biopsy) for testing - under local or general anaesthetic
• the specialist pressing on your tummy and inside your vagina to check for lumps, tenderness or other abnormalities

Causes of postmenopausal bleeding

There can be several causes of postmenopausal bleeding.

The most common causes are:

• inflammation and thinning of the vaginal lining (atrophic vaginitis) or womb lining (endometrial atrophy) - caused by lower oestrogen levels
• cervical or womb polyps - growths that are usually non-cancerous
• a thickened womb lining (endometrial hyperplasia) - this can be caused by hormone replacement therapy (HRT), high levels of oestrogen or being overweight, and can lead to womb cancer.

Less commonly, postmenopusal bleeding is caused by cancer, such as ovarian cancer and womb cancer.

Treatment for postmenopusal bleeding

Treatment for postmenopausal bleeding depends on what's causing it.

Causes and treatment for postmenopausal bleeding

• cause could be cervical polyps - the polyps may need to be removed by a specialist
• cause could be vaginal or endometrial atrophy - you may not need treatment, but may be offered oestrogen cream or pressaries
• cause could be endometrial hyperplasia - depending on the type of hyperplasia, you may be offered no treatment, hormone medicine (tablets or an intrauterine system, IUS) or a total hysterectomy (surgery to remove your uterus, cervix and ovaries)
• cause could be side effect of HRT - changing or stopping HRT treatment
• cause could be womb cancer - total hysterectomy will often be recommended, often followed by radiotherapy, chemotherapy, or hormone therapy, or a conbination of treatments
• cause could be ovarian cancer - surgery to remove your ovaries and sometimes your womb (total hysterectomy). You may also have chemotherapy.