Bleeding after menopause

Menopause is the time after you have your last period. Your final periods can be irregular, menopause is confirmed 12 months after your last period. Bleeding or spotting after this point is called postmenopausal bleeding (PMB).

Postmenopausal bleeding needs to be checked out by a doctor. Mostly the cause will be something very simple and treatable but occasionally it is a sign of more serious disease.

It is not normal to bleed or spot 12 months or more after your last period.

Bleeding after menopause is usually a sign of a minor health problem but can sometimes be an early sign of more serious disease.

When detected early, most conditions causing bleeding after menopause (including cancer) can be successfully treated.

No preparation is necessary. You will be asked to go to the toilet and empty your bladder prior to the test being performed.

If you are wearing a tampon, it will need to be removed. If you are having a period this is not a problem and in some instances it is an advantage when assessing a variety of gynaecological problems.

You may be asked to sign a consent form prior to having the test. It is a good idea to wear comfortable clothing that gives easy access to the lower part of your body.

After emptying your bladder you will be asked to undress from the waist down and you may be asked to wear a gown. You will then be asked to lie on an examination couch. Generally a sheet is provided to cover you. 

You will be asked to bend your legs and the transducer is inserted into the vagina. The transducer is slightly larger than a tampon and especially shaped to fit comfortably into the vagina. 

A protective cover is placed over the transducer and warm lubricating gel is applied to it for ease of insertion. It is gently moved around and pictures or images of the pelvis are obtained.

If you do not wish to have a vaginal ultrasound you can request a trans-abdominal ultrasound be performed instead. You should inform the reception staff of this as you will need to drink 2-3 glasses of water 30 minutes prior to your test and have a full bladder. 

A trans-abdominal ultrasound uses a smooth, hand-held transducer. The abdomen is exposed and warm water based clear gel is applied to the skin and the transducer is moved gently across the abdomen with a sliding and rotating action.

The sonographer uses a small, hand-held device called a transducer (or probe), which transmits ultrasound waves which are relayed back to produce images or pictures on to an ultrasound screen. The examination is performed in ‘real time’, and the images you see on the screen show the inside of your pelvic area. Pictures are taken during the examination.

According to recent studies, more than 90% of the time, post menopausal bleeding is not caused by a serious condition. Most likely your bleeding is caused by a noncancerous condition, such as vaginal atrophy, uterine fibroids, or polyps. But postmenopausal bleeding should always be checked out by your doctor to exclude endometrial cancer.

Irregular bleeding before going through menopause is common, however, it is not normal to bleed or spot 12 months or more after your last period. An estimated 4 to 11 % of women experience vaginal bleeding after they go through menopause. Your bleeding is usually a sign of a minor health problem but can sometimes be an early sign of more serious disease.

Physical and mental stress can have a negative impact on your body in several ways and might cause spotting between periods. However, if you are experiencing post menopausal bleeding, you should always contact a doctor.

You can either have a vaginal ultrasound or a trans-abdominal ultrasound. Both the procedures aim to obtain images of your pelvic. Procedures that rely on histological assessment (e.g., dilatation and curettage, hysteroscopy, and endometrial biopsy) can be more accurate but also more invasive.