Postmenopausal Bleeding
Postmenopausal bleeding refers to any vaginal bleeding that occurs 12 months or more after a woman's last natural menstrual period. This may include spotting, pink/brown/watery discharge, bleeding after sex, or bleeding similar to a menstrual period. Any bleeding after menopause is considered abnormal and should be assessed by a specialist.
Commonality
Postmenopausal bleeding is relatively common and can occur for a variety of reasons.
Most cases are caused by benign conditions. However, approximately 10–15% of women with postmenopausal bleeding are diagnosed with endometrial (womb) cancer, which is why medical assessment is essential.
Causes
There are several possible causes of postmenopausal bleeding.
Common causes include:
Endometrial atrophy – thinning of the womb lining
Vaginal atrophy – thinning and dryness of vaginal tissues
Endometrial polyps – benign growths inside the uterus
Cervical polyps – small non-cancerous growths on the cervix
Hormone replacement therapy (HRT)
Endometrial hyperplasia – thickening of the womb lining
Endometrial cancer – cancer of the womb lining
Less common causes include:
Cervical cancer
Vaginal cancer
Infection
Trauma to vaginal tissues
Certain medications, including tamoxifen and anticoagulants
Risk factors include:
Symptoms
Symptoms may include:
Vaginal bleeding after menopause
Light spotting
Pink, brown or watery vaginal discharge
Bleeding after sexual intercourse
Bleeding similar to a menstrual period
Intermittent or persistent bleeding
Pelvic discomfort or pressure
Recurrent episodes of bleeding
Effects on Fertility
Diagnosis
Assessment usually begins with a consultation, medical history and examination.
Investigations may include:
Transvaginal ultrasound scan – measures the thickness of the womb lining
Saline infusion sonohysterography – provides clearer imaging of the uterine cavity
Hysteroscopy – examination of the womb lining directly with a small camera
Endometrial biopsy – testing for pre-cancerous or cancerous changes
These tests help identify the cause of bleeding and assess for conditions such as polyps, endometrial hyperplasia or cancer.
Is postmenopausal bleeding always cancer?
The majority of women with postmenopausal bleeding do not have cancer.
However, because bleeding can be an early warning sign of endometrial cancer, it should never be ignored. When cancer is detected early, treatment outcomes are excellent.
Treatments
Treatment depends on the underlying cause of the bleeding.
Treatment options may include:
Vaginal oestrogen therapy for vaginal atrophy
Removal of polyps using hysteroscopy
Adjustment of hormone replacement therapy
Treatment of endometrial hyperplasia
Surgical treatment if cancer or significant abnormalities are detected
Management is tailored to the individual diagnosis and patient needs.
Ongoing Care
Living with the Condition
Experiencing bleeding after menopause can be worrying, particularly because many women fear it may be a sign of cancer. However, most cases are caused by benign conditions and can be treated effectively once the cause is identified.
While postmenopausal bleeding cannot always be prevented, measures that may support overall gynaecological health include:
Maintaining a healthy weight
Regular physical activity
Avoiding smoking
Reviewing hormone therapy with a doctor
Attending routine health checks
The most important step is seeking prompt medical assessment if any bleeding occurs after menopause.
When to See a Specialist
You should seek specialist assessment if you experience:
Any vaginal bleeding after menopause
Spotting or bleeding after sex
Pink, brown or watery vaginal discharge
Pelvic discomfort or pressure
Recurrent episodes of bleeding
Even if the bleeding stops on its own, it is important to have it investigated. Early assessment can provide reassurance and ensure any underlying condition is identified and treated promptly.