Post menopausal bleeding (PMB) is any vaginal bleeding that happens more than 12 months after your final period.
In about 90% of cases, PMB is caused by a benign ( non cancerous) issue such as:
- Vulvo-vaginal atrophy due to lower estrogen levels
- HRT- bleeding can occur within the first few months of starting or changing HRT.
- Benign polyps in the womb
In a smaller percentage of cases, around 10-15%, it can be a sign of endometrial cancer.
You should report any PMB to your GP as soon as possible. Your GP will then refer you to a Gynaecology clinic called a one stop clinic.
At this clinic they can carry out some investigations to exclude serious causes of PMB.
You may have a Transvaginal Ultrasound (internal scan) to examine the uterus.
If the scan shows a thickened lining of the uterus ( endometrium) or other abnormalities, you may then go on to have a Hysteroscopy- which is a more detailed examination of the uterus with a small camera.
Sometimes and endometrial biopsy may be carried out to check for abnormal cells.
There is also a new test available in some NHS trusts and some private gynaecology services called the WID-easy test
The WID -easy test has been designed for peri and post menopausal women who are experiencing abnormal bleeding, and significantly lowers the number of women who need the more uncomfortable invasive procedures like endometrial biopsies and hysteroscopy.
It involves taking a quick and painless vaginal swab to detect specific DNA methylation patterns found in endometrial cancer.
The test has high sensitivity and specificity- meaning it performs well in identifying endometrial cancer accurately and is particularly helpful for women with fibroids or a high BMI where ultrasounds may produce inconclusive results.
If your WID-easy test is negative, the likelihood that you have cancer is less than 0.4%.
If the test is positive, there is a higher likelihood of cancer and you will then be advised on further testing to confirm the diagnosis.
There is more information on post menopausal bleeding on www.rcog.org.uk, and for WID-easy testing at www.aghealth.co.uk