Postmenopausal bleeding specialist 

Bleeding whilst on HRT is extremely common and can affect up to 40% of women. If you’ve just started HRT or changed your dose, vaginal bleeding or spotting can be a very normal part of your body adjusting to the hormonal changes. 

This typically settles down within six months and is not usually a sign of anything serious. However, if the bleeding hasn’t stopped after this time, it’s always a good idea to see your doctor. They may adjust your dosage or change the type of HRT you are taking. For example, it may be that oestrogen gel doesn’t work for you and patches may be more suitable. 

Many women also find the Mirena coil, which delivers progesterone directly to the womb, can significantly reduce bleeding. Every woman is different and it’s essential your HRT is personalised to suit your individual requirements.  

Vaginal bleeding at this time can have many different causes, apart from the side effects of HRT. It is important to stress that in the majority of cases it will be harmless. 

The main reasons include the following: 

• Cervical or uterine polyps: These are growths that are usually non-cancerous, and may need to be removed by a specialist. 
• Vaginal or endometrial atrophy: This can cause inflammation and thinning of the vaginal or womb lining. It may not need treatment, or sometimes topical oestrogen (cream or pessaries) may be prescribed. 
• Endometrial hyperplasia: This is a thickening of the endometrium (the womb lining) and is a common cause of postmenopausal bleeding. It’s often caused by oestrogen levels being too high, compared to progesterone. Treatment includes beginning HRT or, if you are already taking it, adjusting the dosage. Long-term use of HRT can also lead to increased risk of endometrial hyperplasia and has precancerous potential, so any bleeding should always be carefully monitored. 
• Endometrial cancer: Bleeding after menopause can, very rarely, be a symptom of endometrial cancer, a condition that can usually be detected and treated early. Abnormal bleeding is the main symptom, which is easily spotted, along with pelvic pain. Around 6% of women who have postmenopausal bleeding have endometrial cancer. 
• Cervical cancer: Abnormal bleeding after menopause can also be a sign of cervical cancer. Again, it’s rare, but it’s still important to have regular cervical screening (smear tests) and investigate any irregular bleeding. Other symptoms include pain during sex or vaginal discharge. 

Menopause is defined as 12 months without a period, so if you are bleeding after this time, it’s important to speak to a doctor or gynaecologist. In most cases, it will be nothing serious, but it’s always helpful if you can keep a note of the type and frequency of bleeding you are experiencing, to give your doctor as much information as possible. 

If you’re on HRT, it’s completely normal to bleed during the first six months. If it hasn’t settled down after this, you should discuss this with your doctor. They will typically adjust or change your medication and decide whether any further investigations are needed. 

Our menopause specialists are experts in understanding the symptoms women go through at this time of life. If you are experiencing postmenopausal bleeding, they will take a detailed medical history, and spend time discussing your symptoms in detail. 

They may then perform a gentle abdominal or pelvic examination, and carry out a transvaginal ultrasound scan, to check the lining of your uterus and ovaries. They may also carry out a cervical smear. Depending on your individual symptoms, a hysteroscopy might also be recommended, where a telescope is used to examine the cavity of the uterus. 

In most cases bleeding will not require any intervention, just monitoring. Sometimes however, it will require treatment, depending on whether the bleeding is heavy or frequent, and whether or not other symptoms are present. 

Once we have carried out all the necessary tests to find out the cause of your postmenopausal bleeding, we will create a personalised plan for your treatment. This can include the following: 

• Personalised HRT, if it is suitable for you
• Adjusting or changing your existing HRT, including having a Mirena coil fitted
• Topical oestrogen, if your bleeding is due to thinning of your vaginal tissues
• Removal of polyps through surgery

 In the rare cases where we have detected precancerous growths or the possibility of cancer, we will refer you for further specialist investigations.