Gynaecology › Postmenopausal Bleeding
Postmenopausal Bleeding
Periods stop altogether after the menopause. Any bleeding in this period — even light spotting — is a finding that requires assessment. Most causes are benign, but a serious cause must be excluded and that cannot wait.
Main causes
- Thinning of tissue (atrophy) due to falling oestrogen — the commonest cause
- Endometrial polyps
- Thickening of the lining of the womb
- The effect of hormone therapy
- Benign changes arising from the cervix
- Cancer of the womb lining — less common, but early diagnosis is decisive
Assessment
The first step is examination and transvaginal ultrasound. The thickness of the womb lining is measured; a thin, regular lining is reassuring.
If the thickness is above the threshold, or the bleeding recurs, a sample of the lining is taken. Where required, hysteroscopy allows the cavity to be seen directly so that sampling can be targeted.
Treatment
Treatment depends entirely on the cause. In tissue thinning, local oestrogen treatment usually resolves the symptom. A polyp found is removed hysteroscopically. Where there is thickening or cellular change, treatment is planned according to the grade of the finding.
What should not be forgotten
Waiting because "it was only a little spotting and it stopped" is the commonest mistake. A single episode of bleeding after the menopause deserves assessment; the result is usually benign, and that assessment is what sets your mind at rest.
