Bleeding after menopause: see a doctor this week

Why it needs checking

Postmenopausal bleeding is the main symptom of womb cancer, and womb cancer is one of the most treatable cancers when it is found early.

Most postmenopausal bleeding turns out not to be cancer. The majority of cases have another explanation. But it cannot be sorted out by how it looks, how much there was, or how you feel, and that is why the rule is that all of it gets checked.

The reason the rule is absolute is that the alternative, deciding case by case at home, is what causes late diagnosis.

What counts

All of it:

• Heavy bleeding
• Light bleeding
• A single episode of spotting
• Brown or pink discharge
• Bleeding after sex
• Bleeding that stopped on its own

"It was only once" and "it was only a little" are the two most common reasons women wait, and neither changes the advice.

What it usually turns out to be

The common causes, most of which are straightforward to treat:

• Thinning of the vaginal or womb lining caused by low oestrogen, which is the most frequent explanation
• Polyps in the womb or cervix, usually benign
• Thickening of the womb lining, which sometimes needs treatment to prevent it progressing
• Infection or inflammation
• An effect of medication, including some HRT regimes and some breast cancer treatments
• Womb cancer or, less commonly, cervical cancer

What a doctor will do

Referral for postmenopausal bleeding is usually on an urgent pathway, which means being seen quickly. That is standard practice and it is not a sign anyone thinks the worst.

Typically:

• A conversation about your history and any medication
• An examination
• A transvaginal ultrasound to measure the thickness of the womb lining
• A biopsy of the womb lining if the scan suggests it is needed, usually done in clinic
• Sometimes a hysteroscopy, a thin camera examination of the womb

If you are on HRT

Some bleeding patterns are expected on some regimes, particularly in the first three to six months of a continuous regime, and on a cyclical regime a monthly bleed is part of how it works.

But bleeding that is unexpected for your regime, that starts after a settled period, that is heavy, or that continues past six months on a continuous regime, still needs assessing. Being on HRT is a reason to get it checked properly, not a reason to assume it is fine.

Why there is no sign-up on this page

fira treats menopausal symptoms. Postmenopausal bleeding is not a symptom to treat online, and our own assessment stops and refers when someone reports it, before any payment is taken.

So there is nothing to buy here and nothing being sold. What you need is a doctor who can examine you and arrange a scan, and that is your GP.

What to do now

1. Ring your GP practice and say you have had bleeding after the menopause. Those words will get you triaged appropriately.
2. If you cannot get through or cannot get an appointment within a couple of weeks, call 111.
3. If bleeding is very heavy, or you feel faint or unwell, seek urgent care.