Bleeding after the menopause

Any bleeding that happens after your periods have stopped for a year or more should always be checked. That is not a reason to panic — most causes turn out to be harmless — but it is the one gynaecological symptom that should never be ignored or put off.

Why it always needs assessment

Post-menopausal bleeding has many possible causes, and the great majority are benign. However, it can also be the earliest sign of cancer of the womb lining, which is highly treatable when found early.

Because early assessment makes such a difference, the approach is deliberately thorough for everyone, regardless of how light the bleeding was or whether it happened only once.

Common causes

The most frequent explanations are straightforward:

• Thinning of the vaginal and womb lining due to low oestrogen
• Polyps in the womb or cervix
• Thickening of the womb lining
• Effects of HRT or other medication
• Infection or inflammation
• Less commonly, pre-cancerous or cancerous changes in the womb lining

What assessment involves

Assessment usually includes an examination and an ultrasound scan, often performed internally, which measures the thickness of the womb lining.

If the lining is thickened or the picture is unclear, a sample of the lining is taken. This can often be done in clinic with a very fine tube, or during a hysteroscopy, where a thin camera is passed into the womb. Both are usually outpatient procedures.

Getting answers quickly

These investigations are designed to give a clear answer promptly. In most cases the result is reassuring and any treatment needed is simple.

If something more significant is found, being seen early gives the widest range of options — which is the whole reason for taking this symptom seriously.