Post-menopausal bleeding (PMB) is any vaginal bleeding that occurs after the menopause. You are classed as menopausal if you are over the age of 40 and have not had a period for over 1 year.
There are many causes for PMB, but it is important to seek timely specialist help if you are experiencing vaginal bleeding after the menopause. 10% of patients who do not take HRT who have
PMB will have an endometrial hyperplasia or endometrial cancer. Remember, you do not need a GP referral to see Miss Tipples in clinic. You can self-refer with any gynaecological problem.
A thorough history will be taken, followed by an ultrasound scan and pelvic examination. Findings will be discussed, and an endometrial biopsy will be taken in clinic if needed. A biopsy will be offered to ladies where the womb lining is more than 4mm on ultrasound scan. It involves passing a small, thin flexible tube into through the cervix, into the uterus to remove endometrial cells.
This can cause period like cramps and light bleeding/spotting is common afterwards. If you are coming to clinic for a PMB assessment we would recommend taking some simple analgesia such as paracetamol, in case biopsy is required.
The most common cause of PMB is atrophic vaginitis (70%). This condition usually occurs secondary to the fall in the hormone oestrogen that occurs at menopause and results in the tissues of the vagina becoming thin and fragile. This makes them more prone to inflammation and bleeding. If you have this condition, you may also experience vaginal dryness, recurrent urinary infections and discomfort during intercourse.
Miss Tipples can discuss with you, treatments to help manage atrophic vaginitis this includes hormonal and non-hormonal options.
Endometrial polyps or fibroids are found in 15-20% of ladies with PMB. Polyps are localised overgrowth of the cells which line the womb, usually into finger-like projections. Fibroids are more muscular tissue growths on a broad base. Polyps are benign in more than 90% of cases. In any case the excess tissue should be removed so it can be fully examined. This is called a hysteroscopy (please see hysteroscopy tab) and can usually be arranged within 2 weeks of your clinic appointment.
There are 2 types of endometrial hyperplasia (pre-cancer): non-atypical: with 1-3% risk of progression into cancer if left untreated, and atypical: with up to 40% risk of progression into cancer if left untreated. Non-atypical hyperplasia can be treated with a progestogen tablet or intra-uterine system, which can be fitted in clinic. Usually, the recommended treatment for atypical hyperplasia is a hysterectomy. Endometrial cancer would also lead to hysterectomy and other therapy as per the gynaecological cancer team advice. Miss Tipples is the gynaecology cancer / oncology lead for Chichester so is best placed to liaise with the wider team in a cancer diagnosis and perform the operation locally is advised by the MDT.
Other causes of PMB include Hormone replacement therapy (HRT), Ovarian cancer (rare), Vaginal/vulvar/cervical cancer (rare).
