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Postmenopausal Bleeding
Postmenopausal bleeding (PMB) is any vaginal bleeding that occurs after menopause, defined as 12 months or more since your last period. Once you have reached menopause, vaginal bleeding is not normal and should always be checked by a doctor.
While in many cases the cause is not serious, postmenopausal bleeding can sometimes be an early sign of cancer, so prompt assessment is important.
Most cases of postmenopausal bleeding are due to non-cancerous conditions. These include:
Thinning of the vaginal or womb lining (atrophy) caused by low hormone levels
Hormone therapy (MHT) side effects
Polyps (small growths on the cervix or inside the womb)
Infections of the vagina (vaginitis) or womb lining (endometritis)
Less commonly, bleeding can be due to endometrial (womb) cancer, cervical cancer, or other gynaecological cancers. This is why investigation is essential.
You should see your gynaecologist promptly if you experience:
Any vaginal bleeding, even light spotting, after menopause
New blood-stained discharge
Bleeding after sex
Persistent pelvic pain or discomfort alongside bleeding
Do not ignore postmenopausal bleeding, even if it only happens once.
How is Postmenopausal Bleeding Assessed?
Your gynaecologist will ask about your symptoms and medical history and may perform a pelvic examination. Initial tests usually include:
Transvaginal ultrasound scan, which looks at the thickness of the womb lining
Endometrial biopsy, where a small sample of the womb lining is taken for testing
Sometimes a hysteroscopy (using a thin camera to look inside the womb) is needed to check for polyps or abnormal tissue. Cervical screening or swabs may also be carried out if appropriate.
Treatment Options
Postmenopausal bleeding is a relatively common problem and is often caused by non-cancerous conditions. However, because it can sometimes be an early sign of cancer, it is very important to see a gynaecologist for review as soon as possible.
With appropriate assessment and treatment, most causes are managed successfully. If cancer is detected, early diagnosis usually means better treatment outcomes.
You do not need to face this concern alone. Your specialist team will guide you through investigations, explain results clearly, and provide treatment or reassurance as needed.
Treatment depends on the underlying cause.
Vaginal or endometrial thinning may be treated with local oestrogen therapy
Polyps can often be removed during a hysteroscopy
Infections are treated with antibiotics
If cancer is diagnosed, you will be referred promptly to a gynaecological oncology team for further care
Find A Specialist
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Dr Kate van Harselaar
Gynaecologist
