Postmenopausal bleeding

Seeing any bleeding after menopause can be unexpected and worrying. If you've noticed spotting, light bleeding or bleeding that's similar to a period after your periods have stopped, it's natural to have questions.

Postmenopausal bleeding is often caused by conditions that can be treated. However, it's important that any bleeding after menopause is checked by a healthcare professional, even if it only happens once or seems minor.

Postmenopausal bleeding is any vaginal bleeding that occurs after menopause.

You're considered postmenopausal once you've gone 12 consecutive months without having a period.

Postmenopausal bleeding is relatively common and there are several possible causes, most of which aren't serious. However, it isn't considered a normal part of menopause and should always be discussed with a healthcare professional, just to be safe.

Postmenopausal bleeding might look like:

• Light spotting
• Pink or brown discharge
• Bleeding that's similar to a period
• Bleeding after sex

The bleeding may happen once or occur more than once.

Vaginal dryness and thinning tissues

Vaginal dryness is one of the most common menopause symptoms due to the natural decline in oestrogen, which causes the tissues in the vagina to become thinner, drier and more delicate. This can mean they become more easily irritated or damaged, making them more likely to cause postmenopausal bleeding or spotting.

Polyps

Polyps are small, usually non-cancerous growths that can develop on the cervix or within the womb. Although they're often harmless, they can sometimes cause vaginal bleeding.

Changes to the womb lining

In some cases, the lining of the womb (endometrium) can become thicker than normal. This can sometimes lead to postmenopausal bleeding and might need further investigation.

Hormone Replacement Therapy (HRT)

For lots of women*, understanding HRT is an important part of exploring their options to help manage the symptoms of menopause. Some forms of HRT can cause irregular bleeding, particularly during the first few months of treatment as your body adjusts, but it's important not to assume that HRT is the cause of unusual bleeding.

In a small number of cases, postmenopausal bleeding can be associated with more serious conditions, such as endometrial cancer, which is why it's so important that any instance of bleeding after menopause is assessed by a healthcare professional as soon as possible.

Even if the bleeding is very light or has only happened once, it's always safer to get checked.

What to expect during your appointment

Understandably, lots of people feel anxious about seeking help for postmenopausal bleeding as it can feel extremely intimate, personal and worrying.

Feeling prepared can help ease some of that worry, so below are the questions you're most likely to be asked during your appointment:

• When did the bleeding start?
• How often has the bleeding occurred?
• Are you taking HRT medication?
• Are you experiencing any other symptoms?
• What’s your medical history?

If further investigation is required, then you might also need to have:

• A pelvic examination
• An ultrasound scan
• Additional tests, if needed

While medical tests can feel a bit daunting, they're designed to help identify the cause of the bleeding and determine whether any treatment is needed. Getting checked can provide peace of mind and help ensure any underlying issues are addressed as early as possible.

Any instance of postmenopausal bleeding should be assessed by a healthcare professional. Treatment depends on the cause of the bleeding, which will be determined during your appointment.

For example:

• Vaginal dryness can be managed with vaginal moisturisers, lubricants and hormonal treatments
• Polyps can sometimes be removed
• HRT medication might need to be adjusted

The right treatment will depend on your individual circumstances.