Postmenopausal bleeding

What is postmenopausal bleeding?

Menopause is a natural biological process, that marks the cessation of menstruation and of a woman's reproductive years. Menopause is reached when a woman has not had a menstrual period for 12 months, it usually occurs in women between the ages of 45 and 55, however this varies from person to person.

Postmenopausal bleeding refers to any vaginal bleeding that occurs in a woman that has undergone menopause. Since menstruation ceases with menopause, any form of vaginal bleeding after this is considered abnormal, and should be evaluated by a gynaecologist specialist.

What are the causes of postmenopausal bleeding?

There are several causes of postmenopausal bleeding. The most common causes include:

  • Thinning and inflammation of the vaginal lining (atrophic vaginitis) or womb lining (endometrial atrophy) – caused by lower oestrogen levels.
  • Womb or cervical polyps – growths that are usually non-cancerous.
  • A thickened womb lining (endometrial hyperplasia) – this can be caused by hormone replacement therapy (HRT), being overweight, or high levels of oestrogen.
  • Postmenopausal bleeding can also be caused by endometrial or uterine cancer. It can also signal vaginal or cervical cancer.

What is the prognosis of postmenopausal bleeding?

Postmenopausal bleeding can often be successfully treated. In the chance that the bleeding is due to something more serious, the prognosis will depend on the cause, and the stage of the condition.

Do any other symptoms accompany postmenopausal bleeding?

Many women who experience postmenopausal bleeding may not have other symptoms, but in some cases other symptoms may be present such as pain and discomfort. This can depend on the cause of bleeding.

Medical tests to diagnose the cause of postmenopausal bleeding

Tests can be used to diagnose the causes of postmenopausal bleeding.

Examples of tests used to diagnose the cause of postmenopausal bleeding include:

  • Endometrial biopsy

    This procedure involves reaching the cervix to take a sample of tissue lining from the uterus. This tissue can then be tested for the presence of cancerous cells.

  • Dilation and curettage (D&C)

    This procedure involves widening or dilating the cervix to obtain a larger tissue sample. A special tool called a hysteroscope is used to see inside the uterus to identify any potential growths.

  • Hysteroscopy

    This procedure involves a doctor inserting a small camera with a light to examine the uterus and its lining. This method can help a doctor to identify abnormal growths or polyps.

Treatment for postmenopausal bleeding

Treatment depends on what's causing your bleeding and you would need to discuss the options with your doctor.

Cause

Treatment

Cervical polyps

The polyps may need to be removed by a specialist

Endometrial atrophy

You may not need treatment, but you may be offered pessaries or oestrogen cream

Endometrial hyperplasia

Depending on the type of hyperplasia, you might not need treatment. You may be given hormone medicine (tablets or an intrauterine system, IUS) or you may be advised to have a total hysterectomy (surgery to remove your uterus, cervix and ovaries).

Side effect of HRT

Changing or stopping treatment

Womb cancer

A total hysterectomy may be recommended


Can postmenopausal bleeding be prevented?

Most causes of postmenopausal bleeding cannot be prevented.

In the case of endometrial hyperplasia, a cause of heavy bleeding, it cannot be prevented but you can help lower your risk by:

  • Losing weight, if you are overweight.
  • Taking synthetic progesterone, if you already are taking oestrogen, due to menopause or another condition (consult with your doctor).
  • Taking birth control or another medicine to regulate your hormones (consult with your doctor).

Endometrial hyperplasia is most often caused by excess oestrogen and a lack of progesterone. In some cases, the cells of the lining become abnormal, this would be called atypical hyperplasia. This can lead to cancer of the uterus. However, when endometrial hyperplasia is diagnosed and treated early, womb cancer often can be prevented.

Which type of specialist treats postmenopausal bleeding?

A gynaecologist is the specialist who can treat postmenopausal bleeding.

 09-29-2023
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Postmenopausal bleeding

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Dr Deepa Janga - Obstetrics & gynaecology

Created on: 04-28-2020

Updated on: 09-29-2023

Edited by: Jay Staniland

What is postmenopausal bleeding?

Menopause is a natural biological process, that marks the cessation of menstruation and of a woman's reproductive years. Menopause is reached when a woman has not had a menstrual period for 12 months, it usually occurs in women between the ages of 45 and 55, however this varies from person to person.

Postmenopausal bleeding refers to any vaginal bleeding that occurs in a woman that has undergone menopause. Since menstruation ceases with menopause, any form of vaginal bleeding after this is considered abnormal, and should be evaluated by a gynaecologist specialist.

What are the causes of postmenopausal bleeding?

There are several causes of postmenopausal bleeding. The most common causes include:

  • Thinning and inflammation of the vaginal lining (atrophic vaginitis) or womb lining (endometrial atrophy) – caused by lower oestrogen levels.
  • Womb or cervical polyps – growths that are usually non-cancerous.
  • A thickened womb lining (endometrial hyperplasia) – this can be caused by hormone replacement therapy (HRT), being overweight, or high levels of oestrogen.
  • Postmenopausal bleeding can also be caused by endometrial or uterine cancer. It can also signal vaginal or cervical cancer.

What is the prognosis of postmenopausal bleeding?

Postmenopausal bleeding can often be successfully treated. In the chance that the bleeding is due to something more serious, the prognosis will depend on the cause, and the stage of the condition.

Do any other symptoms accompany postmenopausal bleeding?

Many women who experience postmenopausal bleeding may not have other symptoms, but in some cases other symptoms may be present such as pain and discomfort. This can depend on the cause of bleeding.

Medical tests to diagnose the cause of postmenopausal bleeding

Tests can be used to diagnose the causes of postmenopausal bleeding.

Examples of tests used to diagnose the cause of postmenopausal bleeding include:

  • Endometrial biopsy

    This procedure involves reaching the cervix to take a sample of tissue lining from the uterus. This tissue can then be tested for the presence of cancerous cells.

  • Dilation and curettage (D&C)

    This procedure involves widening or dilating the cervix to obtain a larger tissue sample. A special tool called a hysteroscope is used to see inside the uterus to identify any potential growths.

  • Hysteroscopy

    This procedure involves a doctor inserting a small camera with a light to examine the uterus and its lining. This method can help a doctor to identify abnormal growths or polyps.

Treatment for postmenopausal bleeding

Treatment depends on what's causing your bleeding and you would need to discuss the options with your doctor.

Cause

Treatment

Cervical polyps

The polyps may need to be removed by a specialist

Endometrial atrophy

You may not need treatment, but you may be offered pessaries or oestrogen cream

Endometrial hyperplasia

Depending on the type of hyperplasia, you might not need treatment. You may be given hormone medicine (tablets or an intrauterine system, IUS) or you may be advised to have a total hysterectomy (surgery to remove your uterus, cervix and ovaries).

Side effect of HRT

Changing or stopping treatment

Womb cancer

A total hysterectomy may be recommended


Can postmenopausal bleeding be prevented?

Most causes of postmenopausal bleeding cannot be prevented.

In the case of endometrial hyperplasia, a cause of heavy bleeding, it cannot be prevented but you can help lower your risk by:

  • Losing weight, if you are overweight.
  • Taking synthetic progesterone, if you already are taking oestrogen, due to menopause or another condition (consult with your doctor).
  • Taking birth control or another medicine to regulate your hormones (consult with your doctor).

Endometrial hyperplasia is most often caused by excess oestrogen and a lack of progesterone. In some cases, the cells of the lining become abnormal, this would be called atypical hyperplasia. This can lead to cancer of the uterus. However, when endometrial hyperplasia is diagnosed and treated early, womb cancer often can be prevented.

Which type of specialist treats postmenopausal bleeding?

A gynaecologist is the specialist who can treat postmenopausal bleeding.

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