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Postmenopausal bleeding

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.

Non-urgent advice: See a GP if you have postmenopausal bleeding, even if:

  • it's only happened once
  • there's only a small amount of blood, spotting, or pink or brown discharge
  • you don't have any other symptoms
  • you're not sure if it's blood

Postmenopausal bleeding isn't usually serious, but can be a sign of cancer. Cancer is easier to treat if it's found early.

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:

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:

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