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When is postmenopausal bleeding cause for concern?

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Irregular bleeding is a key cause of anxiety for women at any stage of life, but, while common, any sort of spotting or bleeding once a woman is postmenopausal is not normal.

Postmenopausal bleeding may be caused by a range of different factors, and while in most cases it is something minor, it should always be investigated by your doctor to rule out anything serious.

Although about 90% of cases go undiagnosed as they are not deemed to be of medical concern, it is important to be aware of the possibilities for what may be causing your symptoms, so that you can seek out the help you need. Sometimes, you may experience other symptoms in addition to your bleeding, if it is a sign of something more serious. When experienced along with postmenopausal bleeding, the following are common, yet not exhaustive, red flags that something of wider concern may be going on.

Bruising easily

Bruising more easily is commonly experienced as people get older, as your skin naturally becomes thinner, and tissues that support capillaries become more fragile. As your body stops producing oestrogen, your skin also produces less collagen, which can bring on wrinkles, thinner skin, and a tendency to bruise easily.

On its own, bruising easily is not something to be concerned about, however when experienced in conjunction with postmenopausal bleeding, may be a sign there is a problem with the way your blood clots. This may indicate a problem with your liver, or an increased risk of abnormal or spontaneous bleeding.

Fatigue and excessive tiredness

Whilst these are also natural facets of the ageing process, being abnormally tired and feeling unusually weak as well as experiencing postmenopausal bleeding may be a sign of anaemia: a deficiency of haemoglobin, the protein molecule in red blood cells. Haemoglobin carries oxygen from the lungs to the rest of the body's tissue, and transports carbon dioxide released from the tissues back to the lungs.

This lack of oxygen in your body may also cause headaches, ringing in the ears, or make you seem unusually pale. This is a treatable condition and can be managed with careful changes to lifestyle and nutrition.


If you experience nosebleeds regularly, or that last for longer than 20 minutes, this may be a sign that your blood pressure is too high. This may put you at an increased risk of heart disease or stroke. As risks of high blood pressure also increase as we get older, postmenopausal women need to be particularly cautious. Women who experience frequent nosebleeds as well as postmenopausal bleeding also may have a low blood platelet count.

Platelets help blood to clot, and line the inside of your blood vessels. When they are present in low counts, the layer of your blood vessels thin, and cause tiny drops of blood to leak through the spaces. This creates red dots on the skin, and increases the risk of abnormal bleeding.

Blood in your urine

The fall in oestrogen during menopause causes a rise in pH within the vagina, which puts your lower genitourinary tract, the system of organs that connect reproductive organs to those concerned with urine production and release, at a higher risk of infection. Blood in your urine may be a sign of a urinary tract Infection (UTI), haemophilia, a condition where the blood has trouble clotting, which makes it difficult for bleeding to stop, or, in some rare cases, endometrial cancer.

Vaginal discharge

Abnormal vaginal discharge may be a sign of gonorrhoea or chlamydia, both sexually transmitted infections that can be treated with antibiotics. If left untreated, these diseases may spread, and lead to pelvic inflammatory disease, or a more serious infection of the womb, fallopian tubes or ovaries.

You will also typically experience pain when you urinate, or pain in your pelvis. Discharge may range from being pink and watery in consistency, all the way to being dark, and strong-smelling. Typically, discharge caused by gonorrhoea is green.

Which treatments are available?

When you visit your GP about your symptoms, they will most likely run a few tests to determine what is causing the bleeding. These may include transvaginal ultrasounds, where your doctor will use an imagining device to look inside your vagina, or a sonogram, to take a more thorough look at the uterine lining.

Some of these tests can be taken inside your doctor's office, whilst others can be performed at an outpatient surgical centre.

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