Bleeding After Menopause

• Dryness and thinning of the vaginal lining (vaginal atrophy) is the commonest cause. Walls of the vagina often rub against each other and with delicate lining, it is not uncommon to have a tiny spot or smear of blood.
• Cervical or endometrial polyps are benign growths which can also cause bleeding.
• Unscheduled bleeding on HRT: You should seek medical advice if you get unscheduled bleeding.
• Thickened lining of the womb (endometrial hyperplasia): This can be caused by being overweight or by taking Tamoxifen tablets (which are prescribed for treatment of breast cancer). This is a benign condition but carries precancerous potential.
• Endometrial cancer: Only 6% of women with post-menopausal bleeding will have this diagnosis. However, it remains the most important condition that we need to rule out.

You need to seek medical advice either via your GP or gynaecologist.  At London Gynaecology we have daily appointments Monday to Saturday with morning, afternoon and evening appointments during the weekdays for convenience.  Our 24hr booking line is 0207 10 11 700 and same day urgent appointments are available if required.

Your gynaecologist will take a full medical history and perform an abdominal and pelvic examination. A pelvic ultrasound scan is usually performed the same day to assess the lining of the uterus and ovaries. A cervical smear may be performed if necessary.

Depending on the results of your scan, a hysteroscopy may be necessary. This is where a telescope is used to visualise the cavity of the uterus. This can be carried out either under local or general anaesthesia and will be arranged in the near future by your gynaecologist.

Your initial appointment will usually give you a reasonable idea about what may be causing your bleeding. If a smear or biopsy is obtained, the results can be fast-tracked and made available within 3-4 days.

This depends on cause of the bleeding. If it is thought to be vaginal dryness and atrophy, local cream may be prescribed. Cervical or endometrial polyps need to be removed and submitted for further testing. If the bleeding is caused by HRT, this can be changed to a different formulation. If the lining is thickened due to endometrial hyperplasia, sometimes oral progesterone or Mirena IUS can be used to reverse these changes.

Only in 6 out of 100 cases, bleeding after menopause is caused by endometrial cancer. Cancer can sometimes develop in the uterine lining, but this takes a long time to spread through because the uterine walls are so thick. Endometrial cancer is usually diagnosed in Stage 1 and can often be cured by a simple laparoscopic (key hole) hysterectomy. Visit our page on endometrial cancer for more information.

To learn more, visit The Menopause Charity, a dedicated charity that shares fact-based research and provides key insight and expertise.

For more information on menopause, visit our specialist website, London Menopause.