Gynaecology Post Menopausal Bleeding (PMB)

If your periods have stopped naturally for more than year you are you shouldn’t have any menstrual bleeding. Even a little spotting is not normal after menopause. If you have postmenopausal bleeding, make an appointment to see your doctor as soon as possible. It could be caused by a number of health problems, some of which are serious.

Causes of PMB

Polyps: These are growths, usually noncancerous, that can develop in the uterus, on the cervix, or inside the cervical canal. They might cause bleeding.

Endometrial atrophy (thinning of the endometrium): The endometrium, the tissue that lines the uterus, can become very thin after menopause because of lower estrogen levels. This may cause unexpected bleeding which is usually light.

Hormone replacement therapy (HRT) Even the no bleed forms of HRT can cause PMB.

Endometrial hyperplasia: In this condition, the lining of the uterus becomes thick, and bleeding may occur as a result. Obesity may be the cause of the problem. Some people with endometrial hyperplasia may have abnormal cells that can lead to endometrial cancer (cancer of the uterine lining).

Endometrial cancer (uterine cancer): Bleeding after menopause can be a sign of endometrial cancer.

Other causes: Lesions of the cervix, use of certain medications such as blood thinners, and other types of cancer can rarely cause postmenopausal bleeding.

Figuring Out the Cause of PMB

A medical history will be taken to determine what risk factors you have and whether you are on HRT, what your cervical smear history is. An examination of your cervix will be performed if your GP has not already done this.

A Transvaginal pelvic ultrasound: During this a vaginal probe is gently placed inside the vagina. This allows visualisation of the uterus, and in particular of the lining of the womb which should be thin in a postmenopausal woman (not on HRT). If the lining is clearly seen and thin it is very reassuring. If it is not seen clearly (which can be for various technical reasons) or it looks thickened then a direct assessment of the endometrial cavity will be required by performing a hysteroscopy.

Hysteroscopy: During this test performed under a general anaesthetic a small camera with a light is passed through the cervix to inspect the inside of the uterus and look for problems. A biopsy may be taken during this procedure or a polyp or fibroid removed. These will be sent for testing.

How Is Postmenopausal Bleeding Treated?

Treatment depends on the cause of the bleeding.

If polyps are to blame, surgery may be needed to remove them.

Endometrial atrophy can be treated with medication alone.

Simple Endometrial hyperplasia may be treated with progestogen therapy and will often be helped by weight loss in the overweight patient.

Complex hyperplasia is usually treated by hysterectomy

How Is Endometrial Cancer Treated?

Endometrial cancer is usually treated by hysterectomy including removal of the cervix and fallopian tubes and ovaries.

In some cases part of the upper vagina along with nearby lymph nodes will be removed.

People with more advanced endometrial cancer may also need to undergo radiation, hormone therapy, or chemotherapy.

Although bleeding on and off during perimenopause is normal, bleeding after menopause is not. Any postmenopausal bleeding, regardless of how light it is, should be checked out and cancer excluded as soon as possible.

Although there is a very good chance that something minor is causing the bleeding, there is also a chance that cancer could be to blame.

If it is cancer, the sooner you get treated, the more likely you are to have a full recovery.