Consultant Gynaecologist and Specialist in Pelvic Floor Surgery

What is Post Menopausal Bleeding?

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

Post-menopausal vaginal bleeding should always be investigated. In the majority of cases women are reassured as no serious condition is detected, however in 1 in 10 women this may be the first symptom of serious disease including cancer.

What are the causes of Post Menopausal Bleeding?

There are several causes for bleeding after the menopause.

Atrophic changes-The most common cause is due to low estrogen hormone levels which results inflammation of the vagina walls

Polyps -on the cervix (neck of womb) and within the uterus (womb) are common and the majority are non cancerous.

Cancer- In 1 in 10 women, cancer is detected within in the uterus (womb). There is a good chance of cure if it is diagnosed early.

Cancer of the cervix (neck of the womb), vagina and vulva can also cause bleeding.

Precancerous changes within the womb lining can also cause bleeding

Infection of the cervix and vaginal tissues can also cause bleeding

Bladder and bowel problems can also cause bleeding.

How is Post Menopausal Bleeding investigated?

After detailed discussion, abdominal and vaginal (internal) examinations are performed to detect any cause for the bleeding.

An Internal Ultrasound Scan (Trans-vaginal) involves the insertion of a probe with a protective covering into the vagina to assess the thickness 
of the lining of the womb (endometrium) and the ovaries.

If the lining of the womb is thickened, (abnormal after the menopause) this is assessed further by a hysteroscopy.

A hysteroscopy is a short procedure where a thin telescope is passed through the cervix to look inside the uterus (womb) after insertion of a speculum.

Hysteroscopy is usually done as an outpatient (with or without local anaesthesia) or day-case procedure under general anesthesia

Sterile saline water is introduced to open up the cavity of the womb to obtain a clear view and obtain a sample of the lining of the womb for testing in the laboratory. Polyps can also be removed and sent for testing.

Please see hysteroscopy leaflet for more details

What are the risks of a hysteroscopy?

Hysteroscopy is a very safe procedure but there are a few risks that
 can occur as with any medical procedure.

Uterine perforation: (damage to the wall of the womb). This is uncommon and rarely causes damage to others organs. For the majority of cases the damage heals without further intervention.

In the unlikely event that a perforation does occur, the procedure will be abandoned and you will be given antibiotics and admitted for observations.

A laparoscopy (insertion of
a telescope through your umbilicus) may be performed to investigate possible internal organ injury.

Very rarely, a laparotomy (an operation through a larger incision) is necessary to repair any injury.

Pain: Some degree of pain is to be expected and simple analgesia such as paracetamol or ibuprofen should suffice.

Vaginal Bleeding and discharge: it is normal to have some bleeding after a hysteroscopy and this should settle within 2-3 weeks.

Infection: If you experience of a fever, heavy prolonged bleeding, feel generally unwell, or have a smelly vaginal discharge, please contact your GP as you may need antibiotics.

What happens after the procedure?

Following the procedure, the findings will be discussed and management plan will be discussed with you. A follow up appointment is arranged in 1-2 weeks.

You may notice a watery discharge or some light bleeding so it is advisable to wear a sanitary pad.

You may experience mild period-like pain afterwards. If this happens take pain relief as needed.

You should be able to resume normal activities the day after the procedure.