Postmenopausal bleeding: is it normal, and what are the main causes?

Written by: Ms Ravinder Kalkat
Edited by: Conor Lynch

Postmenopausal bleeding is an uncommon occurrence, and is characterised by women experiencing vaginal bleeding after menopause.


In our latest article, esteemed consultant obstetrician and gynaecologist, Ms Ravinder Kalkat, outlines the most common causes of postmenopausal bleeding, and explains what tests will be carried out for women experiencing the abnormal bleeding.

Is bleeding after menopause normal?

Postmenopausal bleeding is not normal at all. Bleeding stops when the hormones in the body stop being produced. This is when menopause occurs. If one bleeds after menopause, there is a one in 10 chance of getting cancer. This is why postmenopausal bleeding needs to be treated urgently.


Should women visit a doctor at the first sign of postmenopausal bleeding?

The general recommendation is that anyone experiencing or suffering from postmenopausal bleeding should be seen within two weeks, so yes, absolutely, you should see a specialist as soon as you notice postmenopausal bleeding.


What are the most common causes of postmenopausal bleeding?

The most common causes of postmenopausal bleeding are mainly benign. Nine out of 10 cases will not have cancer. The most common benign causes include the following:



Can postmenopausal bleeding stop on its own?

Yes, it can stop on its own if the cause is atrophic vaginitis. However, it will not stop on its own if the main cause of the bleeding originates from polyps.


What tests will women with postmenopausal bleeding have?

The gold standard is an ultrasound scan. This gives us an estimation of the endometrial thickness, which is thickness of the lining of the womb. This is responsive to hormones and so we want to check if there is an increase in thickness. The normal thickness is four millimetres, and anything thicker than this can be associated with pre-cancer conditions as well as cancer.


Once the ultrasound scan has been carried out, the next step is local examination to see if the woman is bleeding locally from the vagina, as a result of atrophy, or from the vulva. The third test we would then carry out, if the ultrasound scan shows signs of increased thickness, is a hysteroscopy. If there is any abnormality, we would remove it at the same time as carrying out this test.


How can postmenopausal bleeding be managed?

A hysteroscopy is not only used as a diagnostic examination, but so too as a treatment option because we can remove any abnormality at the time of performing this test. Once the removed tissue is checked in the laboratory, and if it is normal, then we don’t have to do anything else. Thankfully, In most cases, bleeding stops at this stage.


Ms Ravinder Kalkat is a mightily revered consultant obstetrician and gynaecologist who is an expert when it comes to postmenopausal bleeding. Visit her Top Doctors profile today to schedule a consultation with her.

By Ms Ravinder Kalkat
Obstetrics & gynaecology

Ms Ravinder Kalkat is an exceptionally skilled consultant gynaecologist in Sutton Coldfield. She is an expert in the diagnosis and management of a wide range of gynaecological issues.

Among her areas of expertise are fibroids, vulvar disordersgynaecological cancer, endometriosismenstrual disorders, such as heavy periods and menorrhagia.

After acquiring higher surgical training in obstetrics and gynaecology within West Midlands Deanery, she joined the Good Hope Hospital in Sutton Coldfield, where she is now the lead consultant for the Early Pregnancy and Gynaecology Assessment Unit. Following her training, she undertook a special module from the University of Warwick and developed expertise in the management of menopausal problems, like postmenopausal bleeding.

Ms Kalkat is an expert in laparoscopy (minimal access surgery), and regularly performs hysteroscopyhysterectomy and vaginal repair. She also performs endometrial ablation surgery. As a specialist in outpatient treatments, she provides minimally invasive procedures that allow patients to make a faster and safer recovery. 

Additionally, she is accredited by the British Society of Colposcopy and Cervical Pathology (BSCCP) to perform colposcopy for both investigative and treatment procedures.

She also dedicates her gynaecological career to research and teaching. Some of her top research interests include heavy period and menopause, and she has published numerous scientific research papers in renowned peer-reviewed journals. What's more, Ms Kalkat has presented her work at national and international conferences. Furthermore, she is actively involved in teaching and training medical students and higher surgical trainees. She is a senior clinical examiner at Birmingham University.

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