Bleeding after the menopause (Post-menopausal bleeding)

Bleeding after the menopause

We hope that this information leaflet will help you to understand your care options. We hope that you will feel comfortable to ask questions of your health professional so that you can work together to make a plan that meets your needs and priorities.

Remember you can always ask the healthcare professional to explain things differently, explain things again, or to write down information for you.

What is post-menopausal bleeding?

Post menopausal bleeding is any bleeding which a lady has after having gone through the menopause. A lady is considered post-menopausal when she has not had a period for over 12 months.

Should I be concerned if I have had post-menopausal bleeding?

We always take post-menopausal bleeding seriously. We know that around 1 in 10 women with post menopausal bleeding can have endometrial cancer. We also want to exclude other rarer forms of cancer such as cervical or ovarian cancer. We therefore need to be sure we investigate it appropriately and in a timely manner.

Other non-cancerous causes of the bleeding could be:

• Thinning of the vaginal tissues;
• Small non cancerous lumps in the womb (endometrial polyps);
• Hormone replacement therapy.

What happens next?

Your GP has referred you via the ‘post-menopausal bleeding pathway’. This is a service aiming to see and evaluate your bleeding as quickly as possible. We aim to see all patients within two weeks of referral. If you have not received an appointment within two weeks then please see your GP to chase this.

The referral your GP has sent has been reviewed by one of our clinical team, who decide what further appointment you need.

What shall I expect in clinic?

Your referral has been reviewed and you have been booked into the One Stop post-menopausal bleeding clinic. You will first have a scan. The person taking the scan will place a small probe in your vagina and will look at the lining of your womb. You will then be seen by a clinician in clinic.

For some ladies, their symptoms, medical history or scan results may suggest their bleeding needs more extensive investigation. Here a short procedure is done to look inside the womb with a small telescope and a biopsy of the lining of the womb is taken. Included in this leaflet is further information about this procedure.

Patients who will be seen in this clinic include:

• Patients with continuous or recurrent bleeding;
• Patients who have already been investigated for post-menopausal bleeding within the last four months;
• Patients on Tamoxifen;
• Patients who have had previous endometrial hyperplasia;
• Those with certain risk factors which make endometrial cancer more likely.

What is an endometrial biopsy and how is it done?

An endometrial biopsy is where we take a small sample of the lining of the womb (endometrium) and send it away to be analysed under a microscope. This is the most definitive way we have of checking whether there are any problems with the lining of the womb. This is mainly to detect cancer but may also show other non-cancerous changes, which may need treatment or further follow up.

An endometrial biopsy is generally done using a small tube called a Pipelle ©. A speculum is inserted into the vagina and the device passed through the neck of the womb. This then creates a small amount of suction and is moved around to take a scraping of the lining of the womb. During the procedure you may feel some sharp cramping pains but these generally settle quite quickly. The biopsy itself takes less than a minute. You can have pain relief after the procedure if necessary.

When will I get my results?

Your clinician will aim to give you as much information as possible on the day. It will take 1-2 weeks for your clinician to get your biopsy results for full confirmation. They will usually contact you by letter with these results.

For more information please use these links:

https://www.nhs.uk/conditions/post-menopausal-bleeding

Outpatient Hysteroscopy

You can fill out the following table with your healthcare professional. This will help you to think about which option is best for you, given your individual situation. Doing nothing is also an option.

My Options include…	The Benefits Why is this option good for me?	The Risks What is not so good about this option for me?
To have treatment
To do nothing
Alternative treatment(s)

You might also want to ask…

• How quickly should I expect to see an improvement?
• Who should I contact if I have questions after I leave today?
• Do I need to come back to the hospital again? Or to see my GP after today?
• Where can I go to get more information?
• What lifestyle changes could I make to support my recovery?

Remember you can always ask the Doctor to explain things differently, explain things again, or to write down information for you.

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience

We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you. 

Feedback

Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)

If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:

Telephone Patient Services: 0300 123 1732 or via email at: [email protected]

Opening times:

The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please be aware that you may need to leave a voicemail message, but we aim to return your call within one working day. If you are unable to understand this leaflet, please communicate with a member of staff.

Version 2