Postmenopausal bleeding

Menstrual bleeding should cease at the menopause. Postmenopausal bleeding is normal only with certain forms of hormone replacement therapy that cause withdrawal bleeding once a month. Other postmenopausal bleedings may be a sign of a serious disorder, such as cancer of the reproductive tract, and should be investigated by a doctor. Postmenopausal bleeding may range from light spotting to a heavier flow of blood and is usually painless.


What are the causes?

Postmenopausal bleeding can be a symptom of several disorders of the vulva, vagina, cervix, and uterus. The most common and least serious cause of such bleeding is atrophic vaginitis, in which the vagina becomes inflamed due to low levels of oestrogen after the menopause.

Postmenopausal bleeding could be caused by a disorder of the cervix, such as cervical erosion or cancer of the cervix. In these disorders, bleeding from the cervix may be more likely to occur after sexual intercourse. Postmenopausal bleeding may also be the result of a thickened endometrium (the lining of the uterus) or cancerous or non-cancerous growths in the uterus. Cancer of the vulva and vagina may also lead to postmenopausal bleeding, although both of these disorders are very rare.

What might be done?

Your doctor will examine the vagina and cervix to look for abnormalities. If abnormal areas are seen in the vagina, a small sample of tissue may be taken for examination under a microscope. Your doctor may also perform a cervical smear test to check for abnormal cells in the cervix. In some cases, a sample of endometrial tissue may be taken for analysis.

Ultrasound scanning may be carried out to image the uterus and to measure the thickness of the lining. The inside of your uterus may also be examined.

The treatment for postmenopausal bleeding varies depending on the underlying cause. Oestrogen creams that are applied to the vagina may be prescribed to relieve atrophic vaginitis. Surgery may be necessary to remove cancerous growths. Surgery may also be carried out to treat disorders of the cervix and uterus, such as cervical polyps or a thickened endometrium. Postmenopausal bleeding should cease once the underlying disorder has been treated.

ENDOMETRIAL SAMPLING

During endometrial sampling a small sample of tissue is removed from the endometrium (the lining of the uterus) to investigate symptoms such as heavy vaginal bleeding and to rule out cancer of the uterus. The sample is examined under a microscope for abnormalities. The procedure may be slightly uncomfortable but usually lasts for only a few minutes and does not require anaesthesia.