Menopause is usually diagnosed in women over 45 who haven't had a period for more than a year. Any bleeding from the vagina after this needs to be checked by a GP.

What happens at your GP appointment

Your GP should refer you to hospital or a special postmenopausal bleeding clinic for further tests.

If you're over 55, you shouldn't have to wait more than 2 weeks to see a specialist. If you're under 55, you may have to wait longer.

What happens at your hospital or clinic appointment

A specialist, who may be a nurse, will offer you tests to help find out what's causing the bleeding and plan any necessary treatment.

The tests may include:

• a small device being placed in your vagina to scan for any problems (vaginal ultrasound scan)
• an examination of your pelvis and vagina
• a thin, telescope-like camera being passed up your vagina and into your womb to look for any problems (a hysteroscopy) and to take a tissue sample (biopsy) for testing – under local or general anaesthetic

Having a pelvic examination

You'll be asked to remove your underwear and lie down on your back.

During the pelvic examination:

1. The specialist will insert a plastic device (speculum) into your vagina to hold it open so they can see the inside of your vagina and cervix.
2. A small cotton bud (swab) will be wiped over the skin to check for infection or changes in the cells.
3. If the lining of the womb is thicker than normal, a tissue sample (biopsy) may be taken using a thin, flexible plastic tube – this can cause cramps and bleeding, which usually settles quickly.
4. After the speculum is removed, the specialist will put 2 fingers inside your vagina and a hand on your tummy to feel your womb and check for any tenderness.

A pelvic examination can feel uncomfortable. Tell the specialist if you feel too uncomfortable and want them to stop.

Causes of postmenopausal bleeding

There can be several causes of postmenopausal bleeding.

The most common causes are:

• inflammation and thinning of the vaginal lining (atrophic vaginitis) or womb lining (endometrial atrophy) – caused by lower oestrogen levels
• cervical or womb polyps – growths that are usually non-cancerous
• a thickened womb lining (endometrial hyperplasia) – this can be caused by hormone replacement therapy (HRT), high levels of oestrogen or being overweight, and can lead to womb cancer

Less commonly, postmenopausal bleeding is caused by cancer.

Treatment for postmenopausal bleeding

Treatment depends on what's causing your bleeding.

Cause	Treatment
Cervical polyps	the polyps may need to be removed by a specialist
Endometrial atrophy	you may not need treatment, but may be offered oestrogen cream or pessaries
Endometrial hyperplasia	depending on the type of hyperplasia, you may be offered no treatment, hormone medicine (tablets or an intrauterine system, IUS) or a total hysterectomy (surgery to remove your uterus, cervix and ovaries)
Side effect of HRT	changing or stopping treatment
Womb cancer	total hysterectomy will often be recommended