Menopause is usually diagnosed in women over 45 who have not had a period for more than a year.
If you have any bleeding from the vagina after this time, contact your GP.
When to get help
Non-urgent advice: Contact your GP even if:
- there's only a small amount of blood, spotting, or pink or brown discharge
- it's only happened once
- you do not have any other symptoms
- you're not sure if it's blood
Postmenopausal bleeding is not usually serious. But in rare cases it can be a sign of cancer. Cancer is easier to treat if it's found early.
Your GP will ask you about the bleeding. They'll examine your vagina. They'll then refer you to a hospital or a specialist. You may be seen at an ambulatory gynaecology clinic.
Your ambulatory gynaecology clinic visit (video)
What happens at your hospital or clinic appointment
The specialist will do tests to help find out the cause of the bleeding and plan any treatment.
They will examine your pelvis and vagina. They'll usually insert a speculum (plastic device) into your vagina to hold it open. This is to see the inside of the vagina and the cervix.
Your specialist will also press on your abdomen and inside your vagina. This is to check for lumps, tenderness or other abnormalities.
Other tests may include a vaginal ultrasound scan. A specialist will place a small device in your vagina to scan for any problems.
You may need a hysteroscopy. A specialist will pass a thin, telescope-like camera into your vagina, through the cervix and into your womb. They can look for any problems in your womb. They'll take a biopsy (tissue sample) for testing.
Most people will have this procedure at an ambulatory gynaecology (AG) clinic under local anaesthetic.
But some people may be admitted to hospital. This is usually because there is no AG clinic near them. In hospital you'll have the procedure done under general anaesthetic.
Causes of postmenopausal bleeding
There can be several causes of postmenopausal bleeding.
The most common causes are:
- atrophic vaginitis - inflammation and thinning of the vaginal lining caused by lower oestrogen levels
- endometrial atrophy - inflammation and thinning of the womb lining caused by lower oestrogen levels
- cervical or womb polyps - growths that are usually non-cancerous
- endometrial hyperplasia - thickened womb lining caused by obesity, too much oestrogen or, less commonly, hormone replacement therapy (HRT)
In rare cases, the cause of postmenopausal bleeding is cancer, such as womb or ovarian cancer.
Treating postmenopausal bleeding
Treatment depends on what's causing your bleeding:
- cervical polyps - your doctor may recommend the removal of the polyps
- endometrial atrophy - you may not need treatment, but other options are oestrogen cream or pessaries
- endometrial hyperplasia - you may need no treatment, but in some cases, you may need hormone medicine or a total hysterectomy
- a side effect of HRT - changing or stopping HRT treatment
- womb cancer - usually a total hysterectomy (surgery to remove your uterus, cervix and ovaries)
- ovarian cancer - a total hysterectomy (surgery to remove your uterus, cervix and ovaries)
- vaginal cancer - you may need surgery or radiotherapy
If you have cancer, you may need additional treatments other than surgery.
Content supplied by the NHS and adapted for Ireland by the HSE
