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Is postmenopausal bleeding is normal

Is Postmenopausal Bleeding Normal?

When women encounter menopause, usually the women won’t have to bleed through women may sometimes experience additional vaginal bleeding. If she goes through menopause, the gynaecologist will consider it as abnormal bleeding and woman must consult her private gynaecologist. If she finds any spot, she should ask her private gynaecologist. Even if she finds bleeding after sex or if the bleeding very heavy or more than a place spot. The bleeding is irrelevant to an issue with menstruation and may be due to another cause that should be identified. 

Causes of postmenopausal bleeding

Some of the causes of postmenopausal bleeding include:

  • Endometrial atrophy: when the estrogen hormone stops generating due to menopause, then women’s endometrial lining may start to become thinner. As a result, the endometrium lining may bleed.
  • Endometrial Hyperplasia: In this condition, the uterine lining becomes thicker instead of thinner, which causes heavy or irregular bleeding. The reason for this disease is most commonly excess estrogen without the hormone progesterone to balance it. Endometrial hyperplasia sometimes may cause the development of endometrial cancer.  
  • Endometrial cancer: This cancer is caused to the endometrial lining. 10% of postmenopausal women with uterine bleeding experience bleeding due to endometrial cancer.
  • Polyps: These are the growth that can develop in the uterus lining. They are noncancerous but can cause abnormally heavy bleeding. Sometimes these polyps grow inside the cervical canal. There will be bleeding to the women during sex when this polyp occurs.

Other causes of postmenopausal bleeding include:

  • Clotting difficulties
  • endometritis – Infection of the uterine lining
  • pelvis trauma 
  • Bleeding from the urinary tract
  • Thyroid disorders 

Hormone medications such as tamoxifen may lead to postmenopausal bleeding a side effect. Many women will undergo breakthrough bleeding as a result of taking hormone replacement therapy in the first six months. 


A private gynaecologist will conduct a test for postmenopausal bleeding by knowing the woman regarding the symptoms that she is experiencing. A gynaecologist will likely question:

  • When she first recognised symptoms
  • How much does she bleed
  • If she has any family history about the problem of postmenopausal bleeding 

By considering woman’s symptoms, the gynaecologist may recommend one or more of several tests. 

Tests that are handled to diagnose the cause of postmenopausal bleeding include:

  • Endometrial biopsy: In this procedure, you can insert a small, thin tube into the vagina to reach the cervix to take a tissue sample from lining from the uterus. The tissue will be tested to identify the abnormal cells such as cancerous cells. 
  • Dilation and curettage: This involves the dilating or widening the cervix to get the large tissue sample. Even there are special tools called hysteroscope to see inside the uterus to identify any potential growths.
  • Sonohysterography: In this procedure, fluid will be injected through the vagina and into the uterus. The gynaecologist will then use an ultrasound machine which uses sound waves to identify differences in tissues to visualise the uterus is known as a transabdominal ultrasound. The procedure can enable a doctor to define whether the uterine lining is thicker or thinner than expected. 
  • Transvaginal ultrasound: In this procedure, the gynaecologist will insert a specific ultrasound probe into the vagina to enable a doctor to visualise the uterus from the bottom rather than from the lower abdomen. 

Most of these tests can be done at the gynaecologist office, and test like D&C is often performed at hospital or surgency centre.

Treatment options 

Postmenopausal bleeding treatments depends on the underlying cause associated with the bleeding. The consultant gynaecologist can consider the information gathered from the testing to work out the best course of treatment. Some of the treatments for specific underlying causes include: 

  • Polyps: Polyps treatments include surgical removal of the polyps so that they can no longer bleed. 
  • Endometrial cancer: Endometrial cancer treatment includes the removal of the uterus and also the nearby lymph nodes to which cancer can spread. This is known as a hysterectomy. Depending upon cancer’s spread, a woman needs to undergo chemotherapy and radiation treatments.
  • Endometrial hyperplasia: for this treatment, the medication is progestins, which help to prevent the endometrial lining from becoming too thick. However, a gynaecologist will recommend regular testing for cancerous cells inside the uterus to ensure that they do not have endometrial cancer.

If a woman has vaginal bleeding because of the thinning of endometrial tissues, a private gynaecologist may direct vaginal estrogen. This medication can overcome the effects of thinning tissues.

 Mrs Sarah Hussain the female gynaecologist can treat any issues related to postmenopausal bleeding. Book an appointment for details regarding this.