Post-menopausal bleeding
What is post-menopausal bleeding? Post-menopausal bleeding is experiencing bleeding from your vagina after you have reached menopause and your periods have stopped. What causes post-menopausal bleeding? Post-menopausal bleeding may not be anything to worry about, but it can sometimes be a sign of cancer, so it is essential to get checked out even if you have experienced a small amount
What it is
Common causes include endometrial atrophy, polyps, hyperplasia, HRT-related bleeding and (in 5–10% of cases) endometrial cancer. The clinical bar for investigation is deliberately low — we do not "wait and see".
Symptoms and signs
- Any vaginal bleeding more than 12 months after your last natural period.
- Bleeding on HRT in a non-expected pattern.
- Persistent watery, blood-stained or offensive discharge.
- Coexisting pelvic pain or pressure.
- Family history of endometrial, ovarian or colorectal cancer (Lynch syndrome).
How we investigate
Same-week consultant assessment with pelvic examination, transvaginal pelvic ultrasound (endometrial thickness threshold 4 mm in non-HRT users), and outpatient hysteroscopy with directed endometrial biopsy where indicated. Tumour markers in selected cases.
Treatment options at The Vesey
- Endometrial atrophy — topical vaginal oestrogen, structured reassurance with documented evidence.
- Polyp removal — outpatient hysteroscopic polypectomy at the same visit where possible.
- HRT review and adjustment — for HRT-related bleeding.
- Endometrial hyperplasia management — Mirena IUS for hyperplasia without atypia; surgical treatment for atypical hyperplasia.
- Cancer pathway — direct gynae-oncology referral with full workup and named-pathway support.
How common is cancer as a cause of post-menopausal bleeding? +
Endometrial cancer accounts for approximately 5–10% of post-menopausal bleeding cases — making it the most important red flag symptom in gynaecology. The reassuring majority have benign causes such as atrophy, polyps or HRT-related bleeding. But distinguishing these requires investigation, not watchful waiting.
What is a hysteroscopy and will it hurt? +
A hysteroscopy is a camera examination of the inside of the womb, done as an outpatient procedure without general anaesthetic. A thin telescope is passed through the cervix. Most women describe period-like cramping during the procedure. It takes about 10 minutes and allows direct visualisation and targeted biopsy of any abnormal area.
Can HRT cause post-menopausal bleeding? +
Yes — HRT-related bleeding is one of the commonest causes of post-menopausal bleeding. Unexpected bleeding on HRT still requires investigation to exclude an underlying endometrial cause. We will review your HRT regimen and adjust it if appropriate once investigation results are available.
What does an endometrial thickness result mean on ultrasound? +
In women not on HRT, an endometrial thickness of 4 mm or less on transvaginal ultrasound is highly reassuring against endometrial cancer. Above 4 mm, or with an abnormal echo pattern, hysteroscopy and biopsy are recommended. On HRT, the threshold and interpretation differ and are reviewed in the clinical context.
Pricing at a glance
Initial rapid-access gynaecology consultation £260. Transvaginal pelvic ultrasound from £240. Outpatient hysteroscopy with biopsy from £1,650 inclusive. Insurance accepted: BUPA, Vitality, AXA, WPA, Cigna, Aviva, Healix.
Book an appointment
When to see a specialist
Book this week. Any post-menopausal bleeding deserves prompt assessment, even if it is light, short or has happened only once.
Cost and pathway
Initial rapid-access gynaecology consultation £260. Transvaginal pelvic ultrasound from £240. Outpatient hysteroscopy with biopsy from £1,650 inclusive.
- Open 7 days including Sundays — 8am to 8pm, no weekend surcharge
- No GP referral required — book directly with our gynaecology team
- Sutton Coldfield location — serving Birmingham, Walsall, Tamworth, Lichfield and the West Midlands
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Sutton Coldfield · Birmingham · Walsall · Tamworth · Lichfield · West Midlands · Open 7 days 8am–8pm
Open 7 days · 8am–8pm · 0121 387 3727