Poste-Menopausal Bleeding (PMB)

Women’s Health Department

Patient information leaflet – Post-Menopausal Bleeding (PMB)

What is Post-menopausal bleeding?

Any bleeding from the vagina after menopause. This can be light spotting, a change in discharge colour or heaver bleeding.

What causes post-menopausal bleeding?

There can be many different causes, including:

• The walls of the vagina become thinner.
• Small skin-tag growths (polyps) in the vagina, cervix or uterus.
• Hormone Replacement Therapy (HRT) making the womb lining thicker.

Most of the time, the cause of post-menopausal bleeding is not serious, but sometimes it can be a sign of cancer of the cervix, vagina or endometrium (womb lining).

Out of 10 women with post-menopausal bleeding, 9 do not have cancer and tests will help find the cause of the bleeding.

The most common cause is an inflammation (swelling) of the lining of the vagina. This is caused by low hormone levels linked to the aging process.

What will happen after my GP appointment?

If you are on HRT your doctor or nurse may have:

• Changed or stopped your HRT and asked to see you again in 3 months to review your symptoms.
  • If your bleeding has stopped after 3 months you may not need further tests
  • If your bleeding has continued you may need further tests. It is important to let the doctor nurse know.
  • Arranged for you to have a trans-vaginal ultrasound scan.

If you are NOT on HRT your doctor or nurse may have:

• Sent a referral for you to the hospital on a suspected cancer pathway, this does not usually mean you have cancer
• Arranged for you have to have a trans-vaginal ultrasound scan.

What happens if I am referred for a scan?

If your GP has arranged for you to have an ultrasound scan at the hospital:

• You will be contacted by the hospital to book an appointment for the scan.
• If you are telephoned, the person contacting you to book the appointment will explain to you if there is anything you need to do to get ready for the scan.
• If you receive a letter with your scan appointment, instructions will be included in the letter.
• Please tell the hospitalbefore your appointment if you:
  • Cannot have internal examinations
  • Have trouble moving
  • Cannot lie on your back for 10 minutes
  • Have had a hysterectomy (removal of the womb)
  • Are unable to attend the appointment

• For this test, a small probe is gently inserted into your vagina to get clear pictures of your uterus, ovaries and fallopian tubes.
• The procedure usually lasts between 15-20 minutes, and you may be asked to empty your bladder before the test.
• The scan looks at the thickness of the lining of your womb (called the endometrium).

What happens after I have the scan?

You will not get your results on the same day. You will get them by letter, phone call or the hospital will arrange another appointment.

If you do not need any more tests you will be discharged back to the care of your GP. If bleeding happens again you should see your GP or nurse.

If your womb lining thickness is more than a certain amount you may need more tests.

The thickness of your womb will be different depending on your age and other factors. Deciding to do more tests is based on national guidelines on what is a normal thickness of womb lining depending on all the different factors.

What happens if I need more tests?

If you are sent for more tests you might have one of the following:

• Endometrial Biopsy

A small sample of the lining of your womb is taken using a thin tube inserted through your vagina into your uterus. The specialist taking the biopsies may also remove any polyps (small skin tag growths).

Any samples taken during will be sent for testing and you will be given the results by letter, phone call or at another hospital appointment. It can take 3 weeks for the test results to be ready.

• Hysteroscopy

A thin camera is inserted through your vagina into your uterus to examine the lining and take small tissue samples if necessary. A hysteroscopy is performed in an outpatient appointment or under a short, light general anaesthetic as a day case procedure and takes about 15 minutes.

The surgeon looks at the cervix with a speculum in a similar way to when you have a smear taken. The cervix is gently dilated (stretched open) and a fibre optic telescope (hysteroscope) is inserted. A camera is attached to this and your surgeon can have a good look at the inside of the womb.

If you are booked in for these extra tests and you take blood thinning medication please tell the hospital before your appointment. You might be asked to stop taking the medicine before you come for the tests.

These extra tests can be uncomfortable for patients.

Taking 2 paracetamol (1g) or Ibuprofen (400mg) 1 hour before your appointment may help.

You can ask the specialist to stop the test at any time if you find it too painful to continue.

Useful contact numbers

Post-Menopausal Bleeding Clinical Nurse Specialists

Mobile number: 07929 376 398

Referral Management Centre: 01432 383 100 – then select option 1

Radiology Department: 01432 804 464

Your experience matters

We aim to provide the care that we would want for ourselves, our families and friends. If you think something could have been done differently, please speak to the department or ward staff. You can contact them by calling the hospital switchboard and asking for the relevant department. Further information about our services is available on our website:

• Phone (hospital switchboard): 01432 355444
• Wye Valley NHS Trust www.wyevalley.nhs.uk

This leaflet is available in alternative formats. If you need this please contact the Patient Experience Team using the telephone number or email below.

After using our services we may ask for your opinion about your experience. Your feedback helps us to make things better for all our patients.

You can also contact the Patient Experience Team by:  

• Phone: 01432 372986 (please leave an answerphone message)
• Email: PALS@wvt.nhs.uk