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Vaginal Bleeding After the Menopause

Any bleeding that occurs after the menopause needs referral to a gynaecologist. If you have gone through the menopause and experience bleeding more than six months after your last period you should contact your GP and ask to be referred. Similarly irregular bleeding whilst taking HRT also needs investigation by a gynaecologist.
Bleeding after the menopause is considered abnormal and may be a sign of the development of cancer of the womb, cervix or vagina. Often a benign cause that is not cancer and not serious is found. However, it is important that a gynaecological opinion is sought to arrange the appropriate investigations.
Assessment of abnormal bleeding would often include an internal, a pelvic ultrasound scan (which is painless) and a hysteroscopy. A hysteroscopy involves passing a fine telescope into the womb and occasionally a biopsy may be taken. This can be done as an outpatient or under general anaesthesia.
In the majority of cases no serious cause for the bleeding is found and a cancer can be excluded. The commonest cause of bleeding after the menopause is vaginal atrophy. This is the thinning of the vaginal tissues which become friable and more likely to bleed. Vaginal atrophy is caused by a lack of the hormone oestrogen, and can be treated by giving local oestrogen replacement. This is not a general HRT and does not carry the risks associated with HRT.
Bleeding on HRT needs investigation to exclude a cancer, and often a slight change in the HRT regime is all that is required.