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Postmenopausal bleeding

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:

  • it's only happened once
  • there's only a small amount of blood, spotting, or pink or brown discharge
  • you do not have any other symptoms
  • you're not sure if it's blood

Postmenopausal bleeding is not usually serious but can be a sign of cancer. Cancer is easier to treat if it's found early.

Your GP may refer you to a hospital or a specialist.

What happens at your hospital or clinic appointment

The specialist may do tests to help find out the cause of the bleeding and plan any treatment.

They'll probably examine your pelvis and vagina. They may insert a speculum (plastic device) into your vagina to hold it open, to see the inside of the vagina and the cervix.

Your specialist may also press on your tummy 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. You'll have this under local or general anaesthetic.

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.

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, levels of 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. In some cases, you may need hormone medicine or a total hysterectomy
  • a side effect of HRT - changing or stopping HRT treatment
  • womb cancer - often a total hysterectomy (surgery to remove your uterus, cervix and ovaries)
  • ovarian cancer - a total hysterectomy (surgery to remove your uterus, cervix and ovaries)

Content supplied by the NHS and adapted for Ireland by the HSE

Page last reviewed: 20 May 2022
Next review due: 8 July 2024

This project has received funding from the Government of Ireland’s Sláintecare Integration Fund 2019 under Grant Agreement Number 123.