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Is it normal to bleed after menopause? We asked a gynaecologist

Red (UK) logo Red (UK) 13/01/2021 Natalie Cornish

Bleeding after menopause can be confusing and worrying, which isn't helped by a lack of open discussion around the subject. This taboo causes lots of women to turn to Google for information, advice and support which is why we went straight to an expert.

One of the most Googled questions is 'Is it normal to bleed years after menopause?' The answer is no. As Professor Stelios Doumouchtsis, a consultant obstetrician and gynaecologist (doumouchtsis.com), explains: 'The menopause is when menstrual periods stop. Women are considered postmenopausal when they have not had a period for one year.' Any bleeding or spotting after this time is known as postmenopausal bleeding or PMB.

If you are suffering bleeding, spotting or brown discharge after menopause, it is important to contact your GP immediately. 'Although bleeding after menopause is nothing serious in many cases, it can sometimes be a sign of cancer,' Professor Doumouchtsis explains. This means early detection and treatment will increase the likelihood of a full recovery.

Here, Professor Doumouchtsis talks Red through the common causes of bleeding after menopause, potential treatment for post-menopausal bleeding and the assessment you should expect in your GP's treatment room.

What is the most common cause of post-menopausal bleeding?

'Bleeding after menopause can be caused by inflammation and thinning of the vaginal skin, or thinning of the lining of the womb. Low oestrogen levels after menopause can result in atrophic changes of the lower genital tract and endometrium (lining of the womb). Polyps of the womb or the neck of the womb (cervix) can also cause vaginal bleeding.

'Thickening of the lining of the womb is another cause of bleeding. This can be a consequence of high oestrogen levels secondary to HRT, being overweight or other causes.


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'Thickening of the lining of the womb is called endometrial hyperplasia and could in some cases progress to cancer. Cancer of the lining of the womb (endometrial cancer) or other gynaecological cancer can present with postmenopausal bleeding.'

Treating bleeding after menopause

'Depending on the cause of bleeding, there are different treatment options available:

  • The management of cervical polyps involves removal of the polyps and histopathological examination (biopsy).
  • Atrophy of the vaginal skin, or endometrium, is usually treated by vaginal oestrogen cream or pessaries.
  • Endometrial hyperplasia requires biopsy first and – according to the type of hyperplasia – treatment can vary from doing nothing, to medical treatment (oral medication, an intrauterine system (IUS, which is a coil releasing a hormone into the endometrium), or a hysterectomy for the removal of the womb, ovaries and cervix.
  • In cases of cancer, specialist care usually involves surgery, such as a hysterectomy with additional treatments depending on the stage of the disease.'

Should you see a doctor if you're bleeding after menopause?

'Yes, if a woman has an episode of postmenopausal bleeding, she should see her doctor for an assessment. This includes a pelvic gynaecological examination, a vaginal ultrasound and a hysteroscopy (telescope in the vagina and inside the womb) if indicated. Even if there is only spotting or brown discharge– or she is not sure and is feeling otherwise well – a doctor’s review is needed.'

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