Postmenopausal bleeding (PMB) is vaginal bleeding that happens at least 12 months after your periods have stopped.

Although it’s a common problem, it’s not normal to bleed even if it’s just spotting. You should make an appointment to see your clinician at the earliest. The cause is usually something minor, but cancer is always a possibility that must be ruled out.

What are the causes of PMB?

The most common causes are:

Inflammation and thinning – of the vaginal lining (atrophic vaginitis) or womb lining (endometrial atrophy) caused by lower oestrogen levels

Cervical or womb polyps – growths, which are usually non-cancerous, that can form in the cervix (neck of the womb) or the womb itself

Thickened womb lining (endometrial hyperplasia) – which can be caused by hormone replacement therapy (HRT), high levels of oestrogen or by being overweight. If left untreated, this can lead to development of womb cancer (also known as endometrial cancer).

About 1 in every 10 women with postmenopausal bleeding will have womb cancer, and in a few cases bleeding may be a sign of another type of cancer such as vulval, vaginal or cervical cancer.

How is PMB assessed?

You will have a thorough assessment including full personal and family history with

An internal examination

Transvaginal ultrasound scan

Endometrial biopsy (tests on a sample of your womb lining)

Hysteroscopy if needed.

After the initial assessment, the results of the examination and scan findings will be discussed with you, and you’ll find out whether you need a biopsy or hysteroscopy. This is mainly determined by the thickness of the womb lining.

If the lining of the womb is thickened, a small sample of tissue (biopsy) may be removed using a fine, flexible plastic tube. This can cause cramps and bleeding, which usually settles very quickly. The test can be stopped if you are finding it uncomfortable.