Postmenopausal bleeding (bleeding after menopause)

Postmenopausal Bleeding: When to Seek Help and What It Could Mean

Bleeding after menopause is always something that should be investigated. While it may not always signal a serious problem, it is considered abnormal — and deserves expert assessment to rule out any underlying causes.

At Happiher, we offer prompt, compassionate support for women experiencing postmenopausal bleeding (PMB). If you’re looking for a private gynaecologist in London for investigation and peace of mind, we’re here to help.

What Is Postmenopausal Bleeding?

Postmenopausal bleeding refers to any abnormal bleeding that occurs more than a year after 12 consecutive months without a period — the point when menopause is considered complete.

The bleeding may be:

• Light spotting or pink discharge

• A full flow resembling a period

• Intermittent or ongoing

Regardless of how heavy or light, any bleeding after menopause should be checked.

Definition and Overview

Postmenopausal bleeding refers to any vaginal bleeding that occurs in a woman who has not had a menstrual period for at least a year. Assessing the last menstrual period is crucial in evaluating postmenopausal bleeding, as it helps determine the patient's menopausal status and potential risks for endometrial cancer. This condition is considered abnormal and requires medical attention. The average age of menopause among American women is 51, and postmenopausal bleeding can occur due to various causes, including hormonal changes, uterine or cervical polyps, fibroids, and certain medications. It is essential to seek medical attention if postmenopausal bleeding occurs, as it can be an early sign of more serious diseases, such as endometrial cancer or uterine cancer.

Is Postmenopausal Bleeding Always Serious?

Not always — in many cases, the cause is benign. However, bleeding after menopause can be an early sign of more serious conditions, including endometrial (womb) cancer. Between 10% and 15% of women who experience postmenopausal bleeding may have endometrial cancer.

It is important to note that certain factors can lead to an increased risk of postmenopausal bleeding. These risk factors include previous health conditions such as fibroids and certain cancers, as well as specific treatments like hormone therapy.

The goal of investigation is to either rule out or diagnose issues early, when treatment is most effective. Addressing postmenopausal bleeding promptly is crucial for maintaining overall health.

Common Causes of Postmenopausal Bleeding

Several common conditions can lead to postmenopausal bleeding, including:

Several common conditions can lead to postmenopausal bleeding, including:

• Endometrial atrophy: thinning of the womb lining due to low oestrogen

• Vaginal atrophy: thinning and dryness of the vaginal walls, often causing spotting or bleeding after sex

• Endometrial polyps: small benign growths inside the uterus

• Cervical polyps: benign growths on the cervix that can cause bleeding

• HRT (Hormone Replacement Therapy): especially in the first few months of starting treatment

• Endometrial hyperplasia: thickening of the womb lining, sometimes with abnormal cells

• Endometrial cancer: cancer of the womb lining, which is why PMB should never be ignored

• Cervical or vaginal cancer (less common)

• Trauma or infection of the vaginal or cervical tissues

The most common causes of postmenopausal bleeding are benign conditions or atrophy of the lower reproductive tract. The ovaries play a significant role in this context, as they produce less estrogen during menopause, leading to various changes in the reproductive system.

Chronic inflammation of the endometrial lining can also lead to postmenopausal bleeding.

The only way to know for sure is to undergo appropriate investigation.

Risk Factors

Several risk factors increase the likelihood of postmenopausal bleeding in women. One significant factor is the decrease in estrogen production during menopause, which can lead to various physical symptoms and health concerns. These include a history of uterine or cervical polyps, fibroids, hormone therapy, and tamoxifen use. Additionally, women with a personal or family history of certain conditions, such as obesity, diabetes, breast cancer, endometrial cancer, or colon cancer, are at a higher risk. Vaginal dryness and sexual trauma can also contribute to the development of postmenopausal bleeding. It is crucial to discuss these risk factors with a healthcare provider to determine the best course of action.

Symptoms and Signs

The symptoms of postmenopausal bleeding can vary from woman to woman. Some common symptoms include light bleeding, light spotting, heavy bleeding, or prolonged bleeding. In some cases, women may experience pelvic pain, brown discharge, or vaginal dryness. Any vaginal bleeding after menopause is considered abnormal and requires medical attention. A healthcare provider will perform a physical exam, take a medical history, and conduct diagnostic tests to determine the cause of the bleeding.

Endometrial Cancer and Its Implications

When to See a Gynaecologist

You should book a gynaecology appointment if:

• You have any vaginal bleeding after menopause, even if it’s just spotting

• You’re experiencing bleeding after sex

• You’ve noticed a watery, pink, or brown discharge

• You’ve had PMB previously but weren’t fully investigated

Many women experience postmenopausal bleeding, and it is important to seek medical advice even if the symptoms seem minor.

At Happiher, we aim to offer same-week appointments, ensuring reassurance and timely answers.

How Is Postmenopausal Bleeding Investigated?

We start with a detailed consultation and a series of gentle, evidence-based investigations to identify the cause. If the initial examination does not reveal the cause, the following tests may be conducted:

These testing methods may include:

• Pelvic ultrasound scan

A transvaginal ultrasound allows us to measure the thickness of the womb lining (endometrium). A thin lining is usually reassuring.

• Saline infusion sonohysterography (SIS)

A specialised scan where fluid is passed into the uterus to detect polyps or abnormalities.

• Hysteroscopy

A camera-based procedure that allows direct visualisation of the womb lining. Polyps can often be removed at the same time.

• Endometrial biopsy

A sample of the lining is taken for analysis to rule out pre-cancerous or cancerous cells.

If a cause is identified, we can move quickly to the appropriate treatment — all in a calm, reassuring environment.

Is Postmenopausal Bleeding Always Cancer?

The majority of women investigated for postmenopausal bleeding do not have cancer — but because it’s one of the early warning signs of endometrial cancer, it’s important not to take a “wait and see” approach. More than 90% of postmenopausal women with endometrial cancer experience postmenopausal bleeding.

Early diagnosis leads to much better outcomes, so even if the bleeding has stopped, please don’t ignore it. Women diagnosed with endometrial cancer have a 95% survival rate when detected before it spreads.

Treatment for Postmenopausal Bleeding

Postmenopausal bleeding treated depends on the cause, and various treatments may be recommended:

• Vaginal oestrogen therapy for atrophy-related bleeding

• Polyp removal via hysteroscopy (often as a day-case)

• HRT review or adjustment if it’s the suspected cause

• Surgical treatment: Surgery may be necessary for conditions like hyperplasia or cancer

• Chemotherapy: May be recommended for treating cancers associated with postmenopausal bleeding

• Progestin therapy: Can help manage bleeding in women using anticoagulants

The treatment for postmenopausal bleeding depends on the underlying causes, such as cervical polyps, vaginal or endometrial atrophy, endometrial hyperplasia, and various cancer types. Each condition presents different treatment pathways, emphasizing the need for tailored approaches based on specific diagnoses.

The underlying cause of postmenopausal bleeding must be identified to ensure it is treated appropriately.

At Happiher, all procedures are explained clearly and carried out with the highest levels of precision, comfort, and privacy.

Prevention and Reduction

While it is not possible to completely prevent postmenopausal bleeding, there are steps that can be taken to reduce the risk. Hormone replacement therapy (HRT) can help alleviate vaginal dryness and reduce the risk of bleeding. However, HRT should be used under the guidance of a healthcare provider, as it can increase the risk of certain cancers. It is important to recognize that any bleeding from the vagina after menopause is abnormal and requires medical evaluation to rule out serious underlying health issues, including malignancies. Maintaining a healthy weight, exercising regularly, and avoiding smoking can also help reduce the risk of postmenopausal bleeding. Regular check-ups with a healthcare provider can help identify any potential issues early on.

Prognosis and Outlook

The prognosis and outlook for postmenopausal bleeding depend on the underlying cause. If the bleeding is caused by a non-cancerous condition, such as vaginal atrophy or endometrial hyperplasia, the outlook is generally good. However, if the bleeding is caused by cancer, such as endometrial cancer or uterine cancer, the prognosis is more serious. Early detection and treatment are crucial in improving the outcome. Treatment options may include medication, surgical treatment, or hormone therapy. In some cases, a hysterectomy may be necessary. It is essential to work closely with a healthcare provider to determine the best course of treatment and improve the prognosis.

Why Choose Happiher for PMB Care?

If you’re seeking a specialist for postmenopausal bleeding in London, Happiher offers:

• Fast access to private consultations and ultrasound scans

• Expert assessment from a consultant gynaecologist with advanced training in minimally invasive procedures

• On-site hysteroscopy and biopsy services at leading London hospitals

• Warm, respectful care in a discreet, supportive environment

Our approach is centered on providing the best possible care for our patients.

We understand that bleeding after menopause can cause worry — and we’re here to provide clear answers and gentle care from day one.

Final Thoughts

Bleeding after menopause is never considered “normal” — but it’s also not something you need to panic about. The most important thing is to get it checked, and to do so with a team you trust.

At Happiher, we’ll guide you through every step, from diagnosis to treatment, with honesty, kindness, and expert care.