Postmenopausal bleeding

Overview

You are in menopause when your last period was at least 12 months ago. The average age for menopause in New Zealand is 50-51 years, but it can range between 40 and 60 years of age.

Possible causes

Any bleeding in the menopause is abnormal and needs to be investigated. Most of the time it is caused by fragile tissues (vagina, endometrium) due to absent estrogen production as the ovaries cease to ovulate eggs (genito-urinary syndrome of menopause and/or instability of the lining of the womb).

Endometrial hyperplasia and cancer may be the cause in 5-10% of cases, and if promptly attended to, treatment is highly successful.

What to do

If you experience bleeding in the menopause, you should see your GP as soon as possible.

How we can help

If you are experiencing postmenopausal bleeding and would like to talk to us about how we can help, please feel free to contact us. You can also request an appointment online.

Further information

Conditions

Genito-urinary syndrome of menopause

When a woman goes through menopause the ovaries stop releasing eggs, and this results in lower levels of estrogen hormone circulating each month. This can cause dryness and even skin tears in the vagina, making sex less comfortable. Some women may also start getting urinary tract infections. Find out more

Hyperplasia and uterine cancer

Endometrial hyperplasia occurs when the inside lining of the uterus (the endometrium) starts to behave abnormally. Whilst not cancer, endometrial hyperplasia is a potential 'pre-cancer'. Risk factors include being over 35, obesity, cigarette smoking and polycystic ovarian syndrome. Find out more

Instability of the lining of the womb

Instability of the lining of the womb is the most common cause of postmenopausal bleeding. It is caused by low estrogen levels, and the tissues become atrophic. The tissue then becomes prone to bleeding and spotting. Find out more

Procedures

Treatment for genito-urinary syndrome of menopause

A simple treatment is to use an estrogen-containing cream. This makes the walls of the vagina healthier and more robust, improves blood supply and helps maintain a healthy bacterial environment. There may also be non-hormonal strategies that can help if you cannot take estrogen replacement.

Hysterectomy

A hysterectomy is when a woman's uterus is removed. This may be because methods to stop heavy bleeding are not successful, side effects of medications are intolerable, fibroids are problematic or endometriosis is severe enough that a more permanent solution is required. Find out more

Hysteroscopy

A hysteroscopy is a common gynaecological procedure, placing a thin camera through the cervix to evaluate the inside of the uterus (the endometrial cavity). This may be as an investigation or a treatment. Find out more

Treatment for instability of the lining of the womb

Treatment is generally not required. Vaginal estrogen treatment may be beneficial. It is important to rule out other causes of bleeding such as abnormal cells within the uterus, or cancer of the uterus. This may necessitate a biopsy.