Bleeding after Menopause
It can be a little concerning to experience bleeding after menopause. While it’s often caused by minor and easily treatable issues, it’s also considered an important red flag symptom. This means you should always chat with your doctor or gynaecologist to get their advice and find out what might be causing it.
What causes Bleeding after menopause?
There are several reasons why you might experience bleeding after menopause. Here are some of the common ones:
- Thickened lining of the womb (Endometrial Hyperplasia): This can happen if you’re overweight or if you’re taking certain medications for breast cancer. While it’s a benign and non-cancerous condition, it does have the potential to become precancerous, so it’s good to get it checked.
- Unexpected bleeding on HRT: If you’re on Hormone Replacement Therapy (HRT) and experience bleeding that’s not part of your expected cycle, it’s a good idea to seek medical advice.
- Vaginal dryness and thinning (Vaginal Atrophy): This is the most common culprit. As we age, the vaginal lining can become thinner and drier. Sometimes, the delicate walls of the vagina can rub together, leading to a tiny spot or smear of blood.
- Benign growths (Polyps): Small, non-cancerous growths called cervical or endometrial polyps can also cause bleeding.
- Endometrial Cancer: This is what we absolutely need to rule out, even though it’s quite rare. Only about 6% of women who experience post-menopausal bleeding will be diagnosed with endometrial cancer.
The most important step if you suffer from any of the causes is to seek medical advice. We have a range of tests and examinations that can help to uncover the cause and identify any treatment you might need.
What causes Bleeding after menopause?
There are several reasons why you might experience bleeding after menopause. Here are some of the common ones:
- Thickened lining of the womb (Endometrial Hyperplasia): This can happen if you’re overweight or if you’re taking certain medications for breast cancer. While it’s a benign and non-cancerous condition, it does have the potential to become precancerous, so it’s good to get it checked.
- Unexpected bleeding on HRT: If you’re on Hormone Replacement Therapy (HRT) and experience bleeding that’s not part of your expected cycle, it’s a good idea to seek medical advice.
- Vaginal dryness and thinning (Vaginal Atrophy): This is the most common culprit. As we age, the vaginal lining can become thinner and drier. Sometimes, the delicate walls of the vagina can rub together, leading to a tiny spot or smear of blood.
- Benign growths (Polyps): Small, non-cancerous growths called cervical or endometrial polyps can also cause bleeding.
- Endometrial Cancer: This is what we absolutely need to rule out, even though it’s quite rare. Only about 6% of women who experience post-menopausal bleeding will be diagnosed with endometrial cancer.
The most important step if you suffer from any of the causes is to seek medical advice. We have a range of tests and examinations that can help to uncover the cause and identify any treatment you might need.
What happens during an appointment?
During your appointment, we will take a full medical history to understand your background and anything from your past that could be contributing to your symptoms.
We will perform an abdominal and pelvic examination, which might include a pelvic ultrasound scan to get a good look at the lining of your uterus and ovaries. A cervical smear might also be done if needed.
Depending on what the scan shows, a hysteroscopy might be necessary. This is a procedure where a tiny telescope is used to view the inside of your uterus. Do we need to put leaflets here? The procedure can be done under general anaesthesia, and results are available within 1-2 weeks
What treatment might be needed?
The treatment will depend entirely on what’s causing your bleeding:
If it’s vaginal dryness and atrophy, a product like Desiral might be prescribed. Cervical or endometrial polyps usually need to be removed and sent for further testing.
If the bleeding is due to HRT, we might suggest changing to a different formulation. For a thickened lining (endometrial hyperplasia), sometimes oral progesterone or a Mirena IUS (intrauterine system) link to page can be used to reverse the changes.
What if it is Endometrial Cancer?
While it’s the most serious possibility, remember that endometrial cancer causes bleeding after menopause in only about 6 out of 100 cases. If cancer does develop in the uterine lining, it usually takes a long time to spread because the uterine walls are quite thick.
The good news is that endometrial cancer is typically diagnosed in Stage 1 and can often be cured with a straightforward laparoscopic (keyhole) hysterectomy.