Bleeding after menopause: is it normal?

Going through menopause can be a confusing time, with hormonal changes causing your body to do things you might not expect. One change that many women welcome is that they stop having periods. So what does it mean if you experience bleeding after the menopause?

What is menopause?

Menopause refers to the time when women no longer have periods due to natural hormonal changes that are part of ageing. As many women find their periods become irregular or less frequent as their hormones change, the menopause is confirmed 12 months after a woman’s last period. 

For most women, menopause happens between the ages of 45 and 55 but it can happen earlier or later. For some women, the menopause is a quick change with few symptoms but for many, it can take longer and involve some uncomfortable symptoms.

Symptoms include hot flushes, night sweats, loss of interest in sex, low mood and difficulty sleeping. Symptoms can last for months or even years before your periods completely stop and can continue for several years after. 

Is bleeding after menopause something to be concerned about?

Bleeding from your vagina after menopause should always be investigated by a doctor to rule out a serious condition. However, in most cases, the cause will not be serious and will be treatable. 

If you are perimenopausal ie your hormones are changing but you have not yet gone through the menopause, you may have vaginal bleeding (spotting) in between your periods, particularly when you are ovulating. 

If you have recently started taking hormone replacement treatment (HRT) for menopause symptoms, this can also cause some vaginal bleeding in some women. 

There are a number of other conditions that can cause vaginal bleeding after menopause, including:  

1. Polyps in the womb

Polyps are noncancerous growths and are quite common in women who have been through menopause. They can grow in the womb or the neck of the womb (cervix). Usually, the only symptom you’ll notice is occasional vaginal bleeding. It is possible for polyps to become cancerous so your doctor will need to monitor them.

2. Thickening or thinning of the womb lining

In a small proportion of women on HRT, bleeding after menopause is caused by a thickening of the womb lining called endometrial hyperplasia. This happens when there is an imbalance of hormones. 

The womb lining can also become thinner, which is known as endometrial atrophy and this can also cause bleeding.

3. Vaginal atrophy

The walls of the vagina can become thinner or inflamed after menopause due to a lack of oestrogen. This can sometimes cause bleeding, especially after sex.

4. Cervical cancer and endometrial cancer

In rare cases, vaginal bleeding after menopause can be a sign of cancer of the cervix or womb. 

Diagnosis

When you visit your GP they will talk to you about your symptoms and may want to do a physical exam. You may be given a blood test or a cervical smear to check for cervical cancer. You may be referred for further tests or to see a gynaecologist (a doctor who specialises in women’s health) to diagnose the cause of your bleeding.

Further test may include: 

Vaginal ultrasound scan

A small probe is placed in the vagina and uses soundwaves to capture images of the inside of your body. This ultrasound scan allows your doctor to closely examine your womb, cervix and ovaries and is used to check for growths and other problems.

Hysteroscopy

A hysteroscopy uses a small, telescope-like camera to look inside your womb. A small tissue sample (biopsy) may be taken for testing. This is usually performed under a local or general anaesthetic. 

Pelvic examination

Your GP or consultant may want to examine your pelvis and vagina. They will use a speculum to hold open your vagina so that it and your cervix can be examined. They may also press on different parts of your lower tummy and inside your vagina to check for tenderness or lumps. 

Treatments

The type of treatment you are given for vaginal bleeding after menopause will depend on the cause. After you have been diagnosed, your GP or consultant will talk to you about treatment options. In some cases, no treatment will be needed. 

Provided there are no signs of cancer, you may be offered one of the following treatments: 

Oestrogen medication

Vaginal or endometrial atrophy is often treated with oestrogen. This may be a cream or gel that you put on your vagina, or it could be in tablet form or a skin patch.

Polyp removal

Polyps are usually removed with surgery. This will be done under either local or general anaesthetic, depending on the size and location of the polyp.

Hormone replacement therapy

The hormone progesterone is sometimes given to treat thickening of the womb lining. 

Hysterectomy

If other treatments are not suitable or unsuccessful, a hysterectomy may be recommended. This is surgery to remove the womb. Sometimes the ovaries and cervix are also removed — your doctor will discuss what is needed with you. 

Always consult your GP

While many causes of vaginal bleeding after menopause are not serious and easily treatable, it is important to see your GP, even if it only happens once or is only a small amount of blood. Your GP can then check that it is not a sign of something more serious and/or give you early treatment to prevent your condition worsening.