Bleeding after menopause (postmenopausal bleeding)

What is postmenopausal bleeding (PMB)?

This is bleeding or spotting that occurs after menopause. Menopause means that you have not had a period in a year or more. You should see your gynaecologist promptly if you experience this.

Why am I experiencing bleeding after menopause?

• Cervical polyps
  Cervical polyps are small growths that can occur on the cervix. Majority are non-cancerous and can be removed in the clinic. 

• Vaginal atrophy
  Women who have menopaused have low estrogen which causes thin and dry vaginal skin that cracks easily.

• Pelvic organ prolapse
  This refers to a drooping of the uterus, bladder or rectum beyond the vagina, and is more common in older women with previous childbirth.

• Uterine (endometrial) polyps
  These are growths are attached to the lining of the uterus (endometrial lining).

• Abnormal uterine lining
  These include pre-cancer (endometrial hyperplasia) and endometrial cancer.  

• Cervical cancer
  This is rare, but is usually associated with a lack of cervical screening.

• Medications
  Blood thinning medications e.g. warfarin, aspirin can cause you to be at increased risk of bleeding after menopause.

What tests do I need?

Your gynaecologist will take a detailed medical history and perform a pelvic examination to check your cervix and uterus. Depending on your symptoms, you may require an ultrasound scan, Pap smear/ HPV test, biopsy of the womb lining or blood tests.

How to treat PMB?

This depends on what the cause of your PMB is. You should speak to your gynaecologist about the treatment options suitable for your condition. These may include:

• Hormonal vaginal creams or tablets: topical vaginal estrogens for vaginal atrophy
• Pelvic floor exercises, vaginal ring pessaries, surgery: for pelvic organ prolapse
• Surgery: for polyps