Postmenopausal bleeding (bleeding after menopause)

Postmenopausal Bleeding: When to Get Help and What It Means

Bleeding after menopause is always something to be investigated. It may not always be serious but it’s abnormal and needs to be checked out.

At Happiher, we offer fast, friendly support for women experiencing postmenopausal bleeding (PMB). If you’re looking for a private gynaecologist in London to investigate and put your mind at rest, we’re here to help.

What Is Postmenopausal Bleeding?

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

The bleeding may be:

• Light spotting or pink discharge

• A full flow like a period

• Intermittent or ongoing

Whatever the amount, any bleeding after menopause should be checked.

Definition and Overview

Postmenopausal bleeding is any vaginal bleeding in a woman who has not had a period for at least a year. Assessing the last menstrual period is key in evaluating postmenopausal bleeding as it helps determine the patient’s menopausal status and potential risks for endometrial cancer. This is abnormal and needs to be seen. The average age of menopause in American women is 51 and postmenopausal bleeding can occur due to various reasons including hormonal changes, uterine or cervical polyps, fibroids and certain medications. If postmenopausal bleeding occurs, it’s essential to get seen as it can be an early sign of more serious diseases like endometrial cancer or uterine cancer.

Is Postmenopausal Bleeding Always Serious?

Not always — in many cases it’s benign. But bleeding after menopause can be an early sign of more serious conditions, including endometrial (womb) cancer. 10-15% of women who experience postmenopausal bleeding will have endometrial cancer.

Note that some factors can increase the risk of postmenopausal bleeding. These include previous health conditions like fibroids and certain cancers and certain treatments like hormone therapy.The aim of investigation is to rule out or diagnose early, when treatment is most effective. Getting seen for postmenopausal bleeding is key to overall health.

Common Causes of Postmenopausal Bleeding

Several common conditions can cause postmenopausal bleeding, including:

Several common conditions can cause 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, that’s 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 big role in this context as they produce less oestrogen during menopause leading to various changes in the reproductive system.

Chronic inflammation of the endometrial lining can also cause postmenopausal bleeding.

The only way to know for sure is to get investigated.

Risk Factors

Several risk factors increase the risk of postmenopausal bleeding in women. One big factor is the decrease in oestrogen production during menopause which can lead to various physical symptoms and health issues. These include a history of uterine or cervical polyps, fibroids, hormone therapy, tamoxifen use. Women with a personal or family history of certain conditions like obesity, diabetes, breast cancer, endometrial cancer or colon cancer are at higher risk. Vaginal dryness and sexual trauma can also contribute to postmenopausal bleeding. It’s essential to discuss these risk factors with your 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 abnormal and needs to be seen. A healthcare provider will do a physical exam, take a medical history and do 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’s important to seek medical advice even if the symptoms seem minor.

At Happiher we aim to offer same-week appointments, so you can get reassurance and answers quickly.

How Is Postmenopausal Bleeding Investigated?

We start with a detailed consultation and a series of gentle, evidence-based investigations to find the cause. If the initial examination doesn’t reveal the cause, we may do the following tests:

These tests 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 special scan where fluid is passed into the uterus to detect polyps or abnormalities.

• Hysteroscopy

A camera-based procedure that allows us to see 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 found we can move quickly to the appropriate treatment — all in a calm and reassuring environment.

Is Postmenopausal Bleeding Always Cancer?

Most women investigated for postmenopausal bleeding don’t 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.Even if the bleeding has stopped don’t ignore it. Women diagnosed with endometrial cancer have a 95% survival rate when detected before it spreads.

Treatment for Postmenopausal Bleeding

Treatment for postmenopausal bleeding depends on the cause and may include:

• 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 needed for conditions like hyperplasia or cancer

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

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

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 has its own treatment pathway so individualised approaches are necessary based on diagnosis.

The underlying cause of postmenopausal bleeding must be identified to be treated properly.

At Happiher we explain everything clearly and do everything with precision, comfort and privacy.

Prevention and Reduction

While it’s not possible to prevent postmenopausal bleeding completely, there are steps that can be taken to reduce the risk. HRT can help with vaginal dryness and reduce bleeding. However HRT should be used under medical guidance as it can increase the risk of certain cancers. Any bleeding from the vagina after menopause is abnormal and needs to be investigated to rule out serious underlying health issues including malignancies. Maintaining a healthy weight, exercising regularly and not smoking can also reduce the risk of postmenopausal bleeding. Regular check-ups with your doctor can help identify any issues early on.

Why Choose Happiher for PMB Care?

If you’re looking for a gynaecologist 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

We put our patients first.

We know bleeding after menopause can be worrying — and we’re here to provide clear answers and gentle care from day one.

Conclusion

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

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