Post Menopausal Bleeding

What is post-menopausal bleeding?

If you are going through, or have gone through, the menopause you may well find that you are still experiencing some vaginal bleeding. In fact post-menopausal bleeding is far from abnormal and is a common reason why many women visit a gynaecologist.

It is not at all unusual to find that your bleeding patterns undergo a change around the time of the menopause or just after starting hormone replacement therapy (HRT). While it is unlikely to be serious, it is worth mentioning it to your GP. If you find that you bleed more than six months after your last period or you notice a change in bleeding pattern more than six months after starting HRT, then it is a good idea to see a gynaecologist to have things checked. In the majority of cases, there is no serious underlying cause and simple investigation and treatment is all that is needed.

Post-menopausal bleeding (PMB)

Many women experience a change in their bleeding pattern around the time of the menopause or just after starting hormone replacement therapy (HRT). This is peri-menopausal bleeding and may not need referral to a gynaecologist at all, however advice and guidance should be obtained from a GP. Where bleeding occurs more than six months after the last period or where a woman experiences a change in bleeding pattern more than six months after starting HRT, then a specialist gynaecological assessment is advisable.

The common causes

The commonest cause of PMB is a condition known as atrophy. This occurs when the vagina and pelvic organs become depleted of oestrogen which is a hormone produced by the ovaries and in much lower quantities after the menopause. The lack of this hormone leads to thinning of the vaginal skin and blood vessels come nearer to the surface, which can lead to soreness and bleeding. Atrophy can easily be treated by using local oestrogen replacement into the vagina with a cream or pessary (vaginal tablet).

Another common cause of PMB is development of a polyp on the cervix or inside the uterus (womb). It is often possible to remove a cervical polyp quite easily during the gynaecology clinic visit but polyps within the uterus usually require a small operation on another occasion.

As mentioned above, in women taking HRT, irregular bleeding is also considered abnormal and requires assessment. However, a serious cause is rarely found and most often a slight change in the HRT prescription is all that is necessary.

Click here to read about the treatment(s) involved in treating post-menopausal Bleeding. If you would like more information or wish to make an appointment regarding post-menopausal bleeding, please get in contact.

Treatment for post-menopausal bleeding

For some women, post-menopausal bleeding (PMB) does have a serious cause. Pre-cancer change or even cancer of the cervix, uterus (endometrium) or the ovaries may be responsible. For this reason we investigate all cases of PMB very carefully to be sure that these causes are excluded. Assessment will involve a vaginal examination at the clinic visit. A cervical smear may also be necessary and usually an ultrasound test is recommended. These tests are of ten all that is required to give reassurance and advice on treatment, but sometimes further tests are required, most commonly a hysteroscopy examination.

Hysteroscopy is performed with either a general or local anaesthetic but is a very minor procedure (less than 5 minutes) which allows the gynaecologist to look inside the uterus by passing a very fine endoscope (camera) through the cervix. This is a very useful test to get more detailed information and to undertake simple treatments for many minor problems (e.g. polyps or small fibroids) which can cause abnormal bleeding.

Special circumstances

Women taking Tamoxifen treatment.
Women who have recently started taking HRT

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