What is post menopausal bleeding?
Post menopausal bleeding refers to any bleeding after the menopause however slight. Even just a brownish discharge, that occurs after the menopause. The usual definition is that it occurs six months or more after the last normal period.
How common is post menopausal bleeding?
Post menopausal bleeding is very common and usually is not serious at all. However, in a small number of women, it will be the first sign of a cancer which is why investigation is advised.
How do I know whether the bleeding is just a late period or abnormal bleeding?
It is very difficult to be sure whether bleeding in the menopause is just the menopause or whether the bleeding is abnormal. The guideline is menopausal bleeding should be investigated if you have not had a period for six months or more. The investigation is usually done as an outpatient and can be completed on one visit.
What are the common causes of post menopausal bleeding?
The skin of the genital tract is very responsive to ovarian hormones, particularly oestrogen. After the menopause, oestrogen levels are very much reduced causing the skin of the whole genital tract to thin. This affects the vulva, the vagina, the skin of the cervix and also the endometrium lining the uterus. The skin in each of these areas is more easily damaged and non specific inflammation may also occur.Usually no site of bleeding is found.
How is Post Menopausal Bleeding investigated?
This involves checking for the possible cancers to make sure they are not present. An ultrasound scan is used to examine the ovaries and also the thickness of the lining of the uterus. A gynaecologist then examines the vagina and cervix. To check the lining of the uterus a pipelle sample may be taken from this area.
What causes bleeding between periods?
Bleeding between periods (intermenstrual bleeding) is often caused by a slight hormone imbalance. If oral contraception has not been taken as prescribed or if the pills haven’t been absorbed properly this can cause bleeding in between periods. Even in a natural cycle, bleeding between period can be caused by a slight disturbance in the normal pattern of activity.
How common is bleeding between periods?
Many women suffer with bleeding between periods. Sometimes it is only spotting between periods. Mid cycle spotting is often associated with ovulation and may be associated with ovulation pain. Bleeding after period is also very common and is usually not of any significance.
Does bleeding between periods need to be investigated?
If the bleeding between periods has only occurred once, investigation is not required. If it is repeated and particularly if it occurs at different times in the cycle, it is more important to investigate it.
What causes bleeding after sex?
Bleeding after sex (post coital bleeding) is very common and is usually caused by bleeding from inside the uterus. This may be because of a slight hormone imbalance. Bleeding from the cervix can occur, particularly if the cervix is inflamed but this is uncommon.
Should bleeding after sex be investigated?
It is important to investigate bleeding after sex, particularly if it has occurred more than once, as very occasionally this can be a symptom of cervical cancer. The cervix needs to be examined carefully, sometimes with a colposcope, and usually a cervical smear is taken.
What is a heavy period?
A heavy period is a period where the blood loss is higher than the average. Most women lose about 30 to 40 ml of blood with each period. Over 60 to 80 ml is considered heavy but most women know if a period is heavy for them. Passing blood clots is a sign that the period is heavy, as is flooding or bleeding through clothes. Needing to use both sanitary towels and tampons is also a sign that the period is very heavy.
What causes heavy periods?
The most common cause is what is called dysfunctional uterine bleeding which just means heavy periods with no other cause found. This is most common in women between 40 and 50 years of age and is often associated with menstrual cycles in which ovulation has not occurred. Other causes include endometriosis, fibroids, polyps and very occasionally cancer of the uterus.
How are heavy periods investigated?
The investigation of heavy periods involves a careful history taken by a doctor and a clinical examination. An ultrasound scan of the pelvis, performed by a competent gynaecological scanner is the most helpful investigation.
What are irregular periods?
An irregular period is when the timing between periods varies from month to month. This is often associated with heavy periods described previously but is also seem in women with polycystic ovarian syndrome.