Abnormal & postmenopausal bleeding: the symptom worth acting on

The short answer

Most abnormal bleeding has a benign cause — hormonal changes, polyps, fibroids or the thinning of tissues after menopause. But because abnormal bleeding (especially any bleeding after menopause) can occasionally be the first sign of changes in the womb lining, it should always be assessed promptly. Getting checked is quick and usually reassuring. This page is part of our gynae-oncology & cancer-prevention programme.

Bleeding after menopause — always get it checked

If you have gone 12 months or more without a period and then bleed — even a single spot — please have it assessed. Postmenopausal bleeding is the symptom never to ignore. The great majority of cases turn out to be benign (most commonly thinning of the vaginal or womb-lining tissue), but it is also the key early warning sign of endometrial (womb-lining) cancer, which is highly treatable when found early. Prompt assessment is exactly how we keep that risk small.

Abnormal bleeding before menopause

Before menopause, bleeding worth checking includes periods that are much heavier or longer than usual, bleeding between periods, or bleeding after sex. These are common and usually have a treatable, benign cause — see our guidance on menstrual disorders and heavy bleeding. A clear, cause-first assessment avoids guesswork and unnecessary treatment.

What we check for

Assessment is straightforward and tailored to you. It usually includes a focused history and examination and a transvaginal ultrasound to look at the womb lining; depending on the findings, a simple hysteroscopy (a look inside the womb) and an endometrial sample may be advised. We explain each step, and most women need only the first, reassuring stage.

• History and focused examination
• Transvaginal ultrasound (womb-lining thickness)
• Hysteroscopy & endometrial sample, only if indicated

Risk factors worth knowing

Some factors modestly raise the risk of womb-lining changes — including being past menopause, a higher body weight, PCOS, diabetes, and taking oestrogen without progesterone. Knowing these helps us assess sensibly; they are not a cause for alarm, and many women with them never develop any problem. Preventive care and healthy weight support reduce risk.

Usually benign — and treatable

The clear message is reassuring: most abnormal and postmenopausal bleeding is not cancer, and when something does need treatment it is usually simple and effective. The single most useful thing you can do is not to wait — an unhurried, respectful assessment gives you a clear answer quickly.

Frequently asked questions