Postmenopausal Bleeding

Postmenopausal bleeding is vaginal bleeding that happens after your periods have stopped. It is not usually serious, but it can be a sign of cancer.

If you receive an appointment to attend the PMB clinic at Cork University Maternity Hospital/SIVUH, here is some information about the clinic, and why it is essential that you attend to have it checked out.

What is the PMB (Postmenopausal Bleeding) Clinic:

This is an outpatient clinic at Cork University Maternity Hospital/SIVUH which looks after women who experience vaginal bleeding after the menopause.

Before this appointment, you will receive an appointment for a pelvic ultrasound. This involves doing an internal (transvaginal) ultrasound scan, looking particularly at the lining of the womb (endometrium), and the ovaries. An internal scan is the best way of looking at the lining of the womb, and this is the one we recommend.

You do not need to fill your bladder before the clinic, as the internal ultrasound scan requires an empty bladder. However, if you have never been sexually active or you are very nervous about having an internal scan, please drink a litre of water one hour before your appointment and talk to the nurse if you wish to request an abdominal scan instead.

What Happens at the clinic?

You will first be seen by a nurse who will check your blood pressure, weight and height and take a urine sample to test it. She will ask you for some information about your problem and your history. You will then see a doctor who may ask some more questions and then do an examination.

This is to look at the neck of the womb (cervix) and the tissues of the vagina using a plastic speculum (also used for taking a smear test). Sometimes, the doctor decides that it is best to take a small sample of tissue (biopsy) from the lining of the womb at the clinic. This is done with a small straw-type device. The procedure lasts less than a minute and can cause some crampy discomfort, which settles quickly.

Why do I need this to be investigated?

Usually, the cause for bleeding after menopause is due to benign causes like thinning of the tissues in the vagina (atrophy), mild infections (vaginitis) and benign overgrowth of tissue (polyps). However, it is essential to ensure there are no severe problems, such as abnormal cells or cancer of the womb's lining or other tissues, as these will need to be treated urgently.

What happens after the clinic?

If the investigations are normal, the doctor will let you know this, and you will not need to have any further visits to the hospital about this complaint in the short term. If you need additional tests, they may include putting a camera inside the womb (hysteroscopy) and taking a sample of the lining of the womb. This will be explained to you at the clinic and arranged from there if required. Usually, there are no after-effects of the examinations, but there might be minor bleeding, especially if you have had a biopsy done. The doctor will type a report at the clinic and send it to your GP to inform them of the findings at the clinic.