Postmenopausal bleeding (PMB) is bleeding from the vagina that happens after a woman has stopped having regular menstrual periods because of menopause. Any vaginal bleeding that occurs 12 months after a woman's last menstrual period is considered PMB.
Symptoms
Many women who experience postmenopausal bleeding may not have other symptoms. But symptoms may be present. This can depend on the cause of bleeding.
Many symptoms that occur during menopause, like hot flashes, often begin to decrease during the postmenopausal time period. There are, however, other symptoms that postmenopausal women may experience.
Symptoms postmenopausal women may experience include:
- vaginal dryness
- decreased libido
- insomnia
- stress incontinence
- increased urinary tract infections
- weight gain
Causes
There can be several causes of postmenopausal bleeding.
The most common causes are:
- inflammation and thinning of the vaginal lining (atrophic vaginitis) or womb lining (endometrial atrophy) – caused by lower estrogen levels
- cervical or womb polyps – growths that are usually non-cancerous
- a thickened womb lining (endometrial hyperplasia) – this can be caused by hormone replacement therapy (HRT), high levels of estrogen or being overweight, and can lead to womb cancer
Less commonly, postmenopausal bleeding is caused by cancer.
Treatment
Treatment depends on what's causing your bleeding.
Cause Treatment
Cervical polyps the polyps may need to be removed by a specialist
Endometrial atrophy you may not need treatment, but may be offered oestrogen cream or pessaries
Endometrial hyperplasia depending on the type of hyperplasia, you may be offered no treatment, hormone medicine (tablets or an intrauterine system, IUS) or a total hysterectomy (surgery to remove your uterus, cervix and ovaries)
Side effect of HRT changing or stopping treatment
Womb cancer total hysterectomy will often be recommended
