Postmenopausal Bleeding
Bleeding after menopause is surprisingly common, but it should never be ignored. While it’s often due to benign causes, it can also be a sign of something more serious — and deserves prompt, expert attention.
What is Postmenopausal Bleeding?
By definition, menopause means no bleeding for at least 12 months. Any vaginal bleeding after this point — even just spotting — is considered abnormal and should be investigated.
Common Causes:
- Endometrial atrophy (thinning of the uterine lining)
- Polyps (benign growths in the uterus or cervix)
- Hormone replacement therapy (HRT)
- Endometrial hyperplasia
- Endometrial or cervical cancer
While cancer is the least common cause, ruling it out quickly is crucial for peace of mind and early treatment if needed.
What I offer
- Prompt ultrasound assessment, usually transvaginal, to check the endometrial thickness
- In-clinic endometrial biopsy, often during the first visit
- Hysteroscopy, if needed, for direct visualisation and treatment
- Individualised care, with options explained in plain English and follow-up arranged without delay
Dr Sam Holford
Why Choose Specialist Care?
Postmenopausal bleeding is never just part of ageing. You deserve answers, reassurance, and expert care.
Book an appointmentFAQs
Why is even a small amount of spotting a concern after menopause?
After menopause (defined as 12 months without a period), the uterine lining should be inactive. Any bleeding, even just a smudge, is abnormal and can be the first sign of a problem, including endometrial hyperplasia or, less commonly, cancer. While most causes are benign, it's vital to investigate promptly.
What is the most common cause of postmenopausal bleeding?
The most common cause is atrophy, which is the thinning of the uterine lining or vaginal tissues due to low estrogen levels. Benign growths like polyps are also a frequent cause. Cancer is the least common cause, but it is the most important one to rule out.
What does the investigation for postmenopausal bleeding involve?
It typically starts with a transvaginal ultrasound to measure the thickness of the uterine lining. Depending on the findings, the next step is often an endometrial biopsy, which is a small sample taken from the lining of the womb in the clinic. Sometimes a hysteroscopy (a camera to look inside the uterus) is also needed.
I'm on Hormone Replacement Therapy (HRT) and have bleeding. Is that normal?
Some patterns of bleeding can be expected with certain types of HRT, particularly in the first few months of starting it. However, any unexpected, heavy, or persistent bleeding while on HRT should still be evaluated by a specialist to rule out other causes.
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Please note: This information is general in nature and not a substitute for medical advice tailored to your specific situation.