WHAT IS POSTMENOPAUSAL BLEEDING (PMB)?
Postmenopausal bleeding is any bleeding from the vagina that happens after menopause.
Menopause is said to have happened when you go 12 months (1 year) without having a period. After menopause any bleeding is not normal. This includes any light spotting or even pinkish discharge. This should always be investigated.
HOW COMMON IS PMB?
Postmenopausal bleeding is very common. It accounts for about 5% of all gynaecological consultations.
What should I do if I have PMB?
You should arrange to see your GP urgently so that it can be quickly investigated.
WHAT ARE THE CAUSES OF POSTMENOPAUSAL BLEEDING?
There are many causes of postmenopausal bleeding. These include:
- Thinning out of vaginal tissue (atrophic vaginitis). This causes about 70% of PMB cases. This means the vaginal tissues become thin and fragile. This is because of a decline in the hormone oestrogen that happens during menopause. This makes the tissues more at risk of bleeding and swelling. It can also cause vaginal dryness and repeated urinary tract infections. This can cause discomfort during sexual activity.
- Localised overgrowths of the cells of the lining of the womb (Endometrial polyps). Polyps can be found in about 15-20% of women with postmenopausal bleeding. They are usually nothing to worry about (more than 90% are not harmful).
- Overgrowth of the inner lining (endometrium) of the womb (Endometrial hyperplasia). They are pre-cancerous. This is diagnosed in up to 10% of women referred with PMB. There are 2 types of endometrial hyperplasia:
Endometrial Hyperplasia without atypia. This has a 5% risk of leading to cancer over 20 years if not treated.
Endometrial hyperplasia with Atypia- This has up to 27.5% risk of leading to cancer if not treated over 19 years. Also there is co-existent cancer of the lining of the womb in 40% of cases.
4. Cancer of the lining of the womb (Endometrial cancer).
5. Other causes
- Hormone replacement therapy (HRT)
- Thinning of lining of the womb (atrophic endometrium)
- Cervical polyps / fibroid
- Vagina / vulva or cervical cancer
- Non-gynaecological causes like trauma or bleeding disorders
Postmenopausal bleeding is usually not serious. In some cases it can be a sign of cancer or a pre-cancerous condition of the womb, cervix, and vagina.
About 1 in 10 women with postmenopausal bleeding may have pre-cancerous cells or cancerous cells in the lining of the womb.
A lot of women with postmenopausal bleeding may feel worried about cancer. 9 out of 10 women referred with postmenopausal bleeding do not have cancer. However, further investigation is needed to rule out any cancer.
WHEN SHOULD I SEE A DOCTOR?
You should see the doctor as soon as possible if you have any postmenopausal bleeding. Your doctor will examine you and organise a referral to the rapid access clinic. This may be virtual or face to face where you will be seen by a gynaecologist.
HOW POSTMENOPAUSAL BLEEDING IS INVESTIGATED?
Pelvic ultrasound scan
This involves scanning your tummy as well as an internal scan. This is called a transvaginal scan. This can check for other causes of bleeding, such as polyps (benign fleshy lumps) in the womb (uterus), or cysts on the ovaries. The scan can also measure the thickness of the womb lining.
You will be asked to empty your bladder before the transvaginal ultrasound scanning.
You will have female support with you. During the scanning a probe is put into your vagina.
Endometrial biopsy
Biopsy of the lining of the womb is offered to women with postmenopausal bleeding if the lining of the womb is more than 4mm in thickness from the measurement on ultrasound scanning.
Endometrial sampling is a sensitive technique to try and look for endometrial cancer. It has detection rates of 97-99%.
Hysteroscopy: this is done by passing a thin telescope through your cervix. We can see inside the womb and take a sample from the lining of the uterus. Any polyp can be removed at the same time. A sample is sent to the laboratory for further examination. This can be done in an outpatient procedure.
A Separate hysteroscopy procedure leaflet is available in the trust.
Sometimes we offer a pipelle biopsy from the lining of the womb in the clinic to make things faster. This is when a tiny, flexible plastic tube (pipelle) is inserted into the womb. Some of the lining cells are removed.
Most women don’t find this procedure too painful. It can be stopped at any point if it feels too uncomfortable
After the procedure, you might want to spend the rest of the day wearing a sanitary towel or panty liner. You may have some spotting or light bleeding.
WHAT ARE MY TREATMENT OPTIONS?
You may not need any treatment. Any treatment will depend on the cause. Your healthcare professional will discuss this with you.
References
https://www.rcog.org.uk/media/ckabsrh3/pmb-poster_2025_final.pdf
Contact Information:
Useful telephone numbers and Website
Cumberland infirmary Women’s outpatient Department-Mon-Fri 08:00-18: 00 -01228814264
West Cumberland Hospital Women’s outpatient Department-Mon-Fri 08:00-17:00-01946523211, Ward1 after 5PM -01946523257
Out of Hours-NHS 111
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For further information on confidentiality contact the Information Governance Team:
Information.Governance@ncic.nhs.uk | 01228 603961
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complaints@ncic.nhs.uk | 01228 936302