Post-menopausal bleeding

Post-menopausal bleeding is not particularly uncommon although it does require examination and history taking to ascertain its cause. Typically the bleeding is temporary and benign, but occasionally it can be something more serious.

If your patient experienced their last menstrual cycle more than 12 months ago, and is now bleeding again, this is a cause for concern and should be investigated thoroughly. When detected early, most conditions that bring on post-menopausal bleeding (including cancer) can be treated successfully.

What causes bleeding after menopause?

Emphasise to your patient that in the vast majority of cases, bleeding post-menopause is not a cause for alarm. Oftentimes, the bleeding is so temporary that its origin is never discovered, and never needs to be. But of course, any unusual symptoms or extreme pain can be an emergency or require treatment quickly.

The most common reasons for post-menopausal bleeding are:

  • A thinning of the lining of the uterus
  • An inflammation and/or thinning of the lining of the vagina (known as atrophic vaginitis)
  • Growths in the uterus or cervix (polyps). Similar to fibroids, these are typically not cancerous
  • Abnormalities in the uterus or cervix
  • A thickened endometrium (referred to as endometrial hyperplasia). This can often be caused by hormone replacement therapy (HRT)

The above are fairly common and usually not serious. But again, we must highlight that a serious underlying cause will be present in around 10% of patients presenting with them. This includes cervical, ovarian and uterine cancers, where clearly time is of the essence. This is why it’s essential for nurses and other healthcare practitioners to be aware of the symptoms and causes of post-menopausal bleeding, and what treatments may be required.

Do you feel confident in understanding why a patient is experiencing post-menopausal bleeding? Do you know the types of questions to ask and how best to phrase them?

If you’re looking to brush up on your skills in this area, you may well find our course Gynae core skills for first contact practitioners particularly useful. Designed specifically for healthcare professionals including first contact nurses, nurse practitioners and practice nurses, it can help you develop the skills necessary to diagnose and advise on a range of gynaecological issues.

This one-day course – worth 7 hours of CPD – is held entirely online so is perfect for interactive learning at a distance. Two dates are currently available: 12th January 2021 and 27th April 2021. All course material, evaluations and certificate of attendance are included, however this course is one of our more popular ones so make sure you sign up early!

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