The menopause is defined as the time after you’ve finished having periods – in fact, you’re officially in your menopause 12 months after your last period. However, some women experience spotting or bleeding after their menopause and this is called postmenopausal bleeding, or PMB.
If you’re experiencing postmenopausal bleeding, then it’s advisable to speak to your GP or menopause specialist as in a small number of cases, it’s a potential sign of something serious.
What can cause postmenopausal bleeding?
Bleeding after your menopause isn’t usually a sign of anything serious, but it does need to be investigated. Common, non-serious postmenopausal bleeding can be caused by:
- A condition called atrophic vaginitis, that causes the lining of the vagina to become thin and inflamed
- A thinning of the lining of the womb
- Non-cancerous polyps in the womb or cervix
- A condition called endometrial hyperplasia, that causes the lining of the womb to thicken and is often caused by taking HRT
- Other abnormalities in the womb or cervix
These conditions can all be diagnosed by having tests and investigations with a gynae doctor or menopause specialist and can be treated relatively easily.
Sometimes, in about 1 in 10 cases of postmenopausal bleeding, the cause can be more serious and can be due to cancerous cells in the womb or cervix. So speaking to a medical professional if you’re experiencing bleeding after the menopause is important.
How is postmenopausal bleeding treated?
Your GP will refer you to a specialist gynae consultant who will then ask some questions about your health and perform some blood tests. They will also use a speculum to look at the inside of your vagina and your cervix to look for any abnormalities. This will be similar to a pap smear test.
You may also need other tests that can help your doctor diagnose the cause of your bleeding. These may include:
- A pelvic ultrasound that may be external over your abdomen (similar to those performed on pregnant women) or internal, using a small wand inside the vagina
- A biopsy of the lining of the womb that is performed under a local anaesthetic using a tiny instrument inserted through the vaginal wall
- A hysteroscopy, which involves passing a long, thin camera into the womb via the vagina to take pictures of the womb lining – you may also have biopsies taken at the same time
- A procedure called a dilation and curettage (D&C) which scrapes away part of the womb lining and is performed under a general anaesthetic
Your treatment will depend on the cause of your bleeding
- Atrophic vaginitis and a thinning of the womb lining are usually treated with hormonal medications similar to HRT. These medications contain oestrogen and are available as oral tablets, gels and creams that you apply to your vagina, skin patches or a vaginal ring.
- Non-cancerous polyps are usually surgically removed – if they’re small and easily accessible, you’ll be given a local anaesthetic and treated as a day patient. If they’re larger and difficult to locate, you may need a general anaesthetic and an overnight stay in hospital.
- Endometrial hyperplasia is also treated with hormonal medications, that contain progesterone. Sometimes, surgery is required to thin the womb lining.
If you’re experiencing bleeding or spotting after your menopause, make an appointment with your GP to help discover the cause and put your mind at rest.