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Post-menopausal bleeding: is it normal?

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Published on: 11 June 2021

That’s it. No more wearing your ugliest under-crackers just in case you ruin them. No more panicking that you’ve forgotten to pack a pad. No more sneaky checks for embarrassing leaks.
No more periods!

It’s probably the single best thing the menopause brings us. And total freedom from all the above nonsense that comes with it.

But what happens when all of sudden – potentially several years into your period-free life – you start bleeding again?

Post-menopausal bleeding may affect up to one in 10 women and of course, if you’ve not had a period for 12 or more months, it’s likely to come as a bit of a shock.

Well, never fear. As always, we’re here to shine a light on this taboo topic – so you can understand what’s normal and what isn’t. We spoke to menopause expert Dr Clare Spencer to find out what exactly might be going on, and heard from one Tribe member on their personal experience.

So what causes post-menopausal bleeding?

Dr Clare Spencer is a registered menopause specialist and GP based in Leeds. She runs My Menopause Centre, a specialist online clinic available nationwide for women navigating their menopausal journey.

Dr Clare explains: “There are multiple reasons women can experience bleeding beyond the menopause.

“Most commonly it’s due to the thinning and inflammation of the tissue of the vagina or lining of the womb as a result of low levels of oestrogen.”

This can occur during the menopause transition and post-menopause. Another frequent cause of bleeding are polyps of the cervix or lining of the womb. Dr Clare explains: “These are like small skin tags, and not normally cancerous.”

HRT can sometimes be to blame too. “Bleeding is common when you first start taking it, when you change a dose, or if you forget to take it. I would advise you to speak to your doctor if you are bleeding on HRT,” says Dr Clare. “It is important that other causes of bleeding are considered so you may need an examination or further investigation. Coming off HRT is an option to see if the bleeding stops, but you may not have to.”

Other causes can include being overweight, your ovaries still producing some hormones, sexually-transmitted infections or if you’re being treated with a tamoxifen therapy for breast cancer.

Talking of the C-word – can that cause post-menopausal bleeding? Dr Clare says: “The chances of there being a serious cause is low, however cancers of the womb lining, the cervix or (very rarely) the vagina, the ovaries or fallopian tubes, can cause bleeding which is why it’s vital you speak to your doctor straight away.”

She says to keep an eye out for other symptoms too, such as bloating and loss of appetite, pain in your lower abdomen, change in bladder or bowel function, unintentional weight loss, pain during sex, feeling of lump in the vagina, persistent irritation and itching down there, and smelly or bloody discharge. Make a note of them and go armed to your GP appointment.

Sarah’s story

Sarah is 55 and started HRT following a private consultation. She was prescribed 25mg oestrogen given in a patch and 100mg progesterone taken orally.

“It certainly worked for a while. It sorted out the hot flushes and night sweats – and generally I just felt good that I’d done something and that my body wasn’t reacting negatively to it,” Sarah explains.

“I still felt anxious and the brain fog was still there, but it did boost my energy levels and I was sleeping – which was obviously fantastic in itself. Although it wasn’t ticking all the boxes, for six to eight months it was going well.”

Sarah remained on this low dose of hormones for a while, and continued to focus on eating a well-balanced diet and exercising frequently. Then the bleeding started. She says: “This wasn’t a bit of light spotting. It was like having a full-blown period which was quite frightening having not had one for two years!”

She sought medical advice straight away.

“I decided I wasn’t going back to the first menopause doctor I’d seen as the experience hadn’t been great. I booked to see another doctor who had great reviews and credentials, and some of my friends had been to her.”

In the consultation, the doctor reassured Sarah that sometimes when you start taking HRT the body just needs to adjust itself.

“She did my bloods and sent me for a scan to check the health of my uterus. I was so relieved when she told me it showed no problems and actually looked very healthy. That’s given me confidence and reassurance there’s nothing untoward going on.

“I was advised to come off progesterone for a week to see if that helped things settle down.”

Sarah is now trying body-identical hormones, using a topical oestrogen and testosterone gel to help with vaginal dryness, and taking a whole raft of supplements on the advice of her menopause specialist.

Despite the tweaks to her menopause plan, Sarah is still experiencing spotting most days. “I haven’t had another full-on ‘period’ but I’m still having to wear a panty liner or use a small tampon. And frankly, that’s a bloody nuisance (if you’ll excuse the pun). I wake up some mornings and think: ‘That’s it. I’m coming off everything!’ I’m going to stick it out though.

“It’s like a matrix – you’re trying things for a week or two at a time and you just have to keep going to find out what works for you. I hate this phrase but it is a journey, and my advice to other women is that you’ve got to have trust in whoever is advising you. ”

We’re with you on that, Sarah.

Can post-menopausal bleeding be prevented?

The simple answer to this is ‘no, not really.’ Although taking care of yourself must count for something, Sarah’s story tells us that like most things to do with the menopause, it’s more often than not all a bit of mystery.

On a brighter note, there are lots of effective treatments out there no matter the cause – from oestrogen creams to polyp removal. What really matters is plonking yourself in front of a doctor as soon as possible to find out what’s going on.

More likely than not there will be some doolally (i.e. hormone-related) but completely benign reason you’ve suddenly reversed to a part of life you were happy to leave behind, and in the case it’s something more sinister, catching it early is key.

The bottom line

Experts estimate that just one week’s delay in a cancer referral can lower chances of survival by 1%. Many of us have put off doctors appointments due to the pandemic, but as Dr Clare says – although the risk is small, this isn’t something you should ignore.

So, what are you waiting for? It doesn’t matter if it's only happened once, or it’s just a bit spotting – it doesn’t even matter if you’re not sure it’s blood – call the doctors.

Together, we’ve got this.

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