A woman is considered to have reached menopause once she has gone 12 consecutive months without a period, after which she is ‘postmenopausal’. A lot of women may not know that bleeding after the menopause is something that should be taken seriously and should always be investigated, even if it is just a small amount of bleeding that happens only once.
“I had no idea bleeding after the menopause wasn’t normal. Like most of us, I am just so used to periods that I just didn’t think it was abnormal once I went through the menopause. It completely took me by surprise that I should get things checked out.” Sophie, 57.
In most cases, the cause is not serious and can be easily treated. However, in around 1 in 10 cases, postmenopausal bleeding may be a sign of a more serious condition such as cancer of the womb (uterus), cervix or ovaries. That’s why seeking medical advice is essential.
Understanding what is and isn’t ‘normal’ when it comes to the menopause isn’t as straightforward as you would think. Every woman experiences menopause differently, so what might be typical for a friend or relative could be completely different for you.
“My friend went through the menopause at 50. Her periods stopped suddenly, and that was it. For me, it was completely different. It took years of changes in my cycle before I officially reached menopause. I didn’t know what to expect—or if something was wrong. I couldn’t remember whether I had had a full 12 months of no periods, so I wasn’t quite sure if it was ‘postmenopausal’ bleeding.” Helen, 58
What Counts as ‘Bleeding’?
Postmenopausal bleeding can include:
- Any episode of vaginal bleeding, even if it only happens once
- A small amount of blood or light spotting
- Pink or brown discharge
You may not have any other symptoms, and the bleeding might be so minimal that it’s easy to dismiss. However, even a small amount of bleeding should not be ignored.
What Can Cause Postmenopausal Bleeding?
While it’s natural to worry, it’s worth knowing that most causes of postmenopausal bleeding are not serious and can be managed with treatment.
Common causes include:
- Atrophic vaginitis or endometrial atrophy – thinning and inflammation of the vaginal or womb lining due to low oestrogen levels
- Polyps – non-cancerous growths on the cervix or inside the womb
- Endometrial hyperplasia – thickening of the womb lining, which can be caused by hormone replacement therapy (HRT), being overweight, or high oestrogen levels
- Gynaecological cancers – including cancer of the womb, cervix, or ovaries, which account for around 10% of postmenopausal bleeding.
What Should I Do If I Notice Bleeding?
There are many possible reasons for bleeding after menopause, and many of them are benign. Still, it’s important to see your GP as soon as possible. They may refer you to a gynaecologist for further investigation.
You may be offered one or more of the following tests:
- Vaginal ultrasound
- Internal (pelvic) examination
- Hysteroscopy – a thin, telescope-like camera inserted through the cervix to look inside the womb
- Biopsy – a small sample of tissue from the womb or vaginal lining
While these tests may sound daunting, they are usually quick and are often carried out under local or general anaesthetic to minimise discomfort. You’ll be cared for by experienced professionals who will do their best to make the process as smooth as possible.
What Are the Treatment Options?
Treatment depends on the underlying cause and may include:
- Removal of polyps
- Hormone therapy – such as oestrogen creams, pessaries, or tablets
- Changes to HRT – adjusting your current hormone treatment or starting HRT if needed
- Surgical options – including hysterectomy in some cases
Final Thoughts
There is no such thing as a ‘normal’ menopause experience—but one thing is clear: any bleeding or spotting that occurs 12 months or more after your last period is not normal and should be investigated. The earlier the cause is identified, the more effective the treatment.
Names have been changed to protect privacy.
If you’re experiencing postmenopausal bleeding or have concerns about your gynaecological health, our GPs are available for same-day or next-day appointments. Consultations with our specialist gynaecologist can typically be arranged within one to two weeks. Phone 01202 110303 email hello@thehavenmedical.com.