Resources / Bleeding After Menopause

Bleeding After Menopause

Menopause occurs when menstrual periods stop as levels of the reproductive hormones estrogen and progesterone decline. The average age of menopause in the UK is 51 years, and after this, menstrual bleeding should no longer occur.  Some women will, however, experience vaginal bleeding after menopause, and this is referred to as postmenopausal bleeding.

Postmenopausal bleeding occurs in about 10% of women over age 55. It can be light or heavy and may be caused by a range of conditions, most of which are not serious. However, in approximately 10% of cases, postmenopausal bleeding may be a sign of a more serious problem, and for this reason, it is important to have any bleeding after menopause checked by a doctor.

Doctor helping with Menopause patients

What causes postmenopausal bleeding?

Common causes of postmenopausal bleeding include:

  • inflammation and thinning of the lining of the vagina (vaginal atrophy) or uterus (womb) (uterine atrophy), as a result of estrogen loss
  • non-cancerous growths (polyps) in the neck (cervix) or body of the uterus
  • thickening of the lining of the uterus (endometrial hyperplasia)
  • other abnormalities of the cervix or uterus
  • sub-optimal dosing of hormone replacement therapy (HRT)

What should I do if I have postmenopausal bleeding?

All postmenopausal bleeding should be discussed with your doctor and you may need to be referred to a gynaecologist. Assessment will usually include a medical history and a vaginal examination. A cervical smear may be taken as well as blood tests depending on the likely cause. One or more of the following investigations will usually also be performed:

  • A pelvic ultrasound scan to assess the cervix, endometrium (lining of the uterus) and ovaries
  • A pipelle test to take a small sample or biopsy of the endometrium
  • A hysteroscopy, where a thin tube is inserted through the cervix so that the endometrium can be viewed directly.  A sample or biopsy may also be taken for testing 
  • A dilation and curettage (D&C) to remove tissue from the endometrium and test it. This is done under a general anaesthetic

Less commonly, postmenopausal bleeding is caused by a cancer in the cervix, ovary or lining of the uterus (endometrium).

How is postmenopausal bleeding managed?

The management of postmenopausal bleeding will depend on the cause.

  • Atrophic vaginitis and endometrial atrophy will usually be treated with HRT or vaginal estrogen 
  • Polyps are usually removed with surgery. Depending on the size and location, they may be removed in the outpatient clinic under local anaesthetic or in hospital under general anaesthesia
  • Thickening of the endometrium or endometrial hyperplasia, is usually treated with hormone therapy
  • Where a cancer is detected, referral to a gynaecological oncologist will usually be necessary for appropriate management. This may include surgery, chemotherapy, or radiotherapy or a combination of these depending on the cause. Fortunately, most cancers can be effectively treated if detected early

All treatments should be discussed with you so that you understand why one particular treatment or test is recommended over another.

Why NewWoman Health?

At NewWoman Health we have a commitment to educating, advising, treating and supporting women approaching, during, and following menopause. Our wide range of medical and lifestyle interventions help women to manage or minimise their menopause symptoms and improve their quality (and potential longevity) of life in an aspirational and uplifting way.

If you’re concerned or have questions about the menopause transition and/ or other menopause-related problems, including treatment options, our menopause specialists can support you with personalised medical consultations that take into account your medical history, lifestyle and preferences.

Take the next step in ensuring your long-term health and quality of life by booking a consultation with us today.


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You are not alone. As a local example, in Manchester over 46% of council employees are female and over 40 years old. In a CIPD survey (2019) over 30% of women said they were unable to work because of menopausal symptoms.

Only 25% said they could tell their manager the real reason for their absence. The Council account for nearly 7% of all employment in Manchester. They implemented a new Menopause policy in March 2022. CIPD survey | Manchester Council Menopause Policy | CIPD Manchester

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