After menopause
Any vaginal bleeding 12 months or more after your last period. Always needs prompt investigation; most causes are benign, but it should never be ignored.
Understanding
Bleeding after the menopause should always be checked. The good news is that the majority of cases are caused by benign conditions: vaginal or womb-lining thinning (atrophy), polyps, or thickening of the lining (hyperplasia).
A small proportion of cases relate to endometrial cancer, which is highly treatable when picked up early. That is why Mr Orabi recommends a one-stop appointment with examination, scan and biopsy in the same visit wherever possible, to give you a clear answer as quickly as possible.
Common symptoms
Light spotting or staining on underwear
Heavier bleeding
Pink, brown or red discharge
Bleeding after sex
Diagnosis
Approach
A structured workup, often within one appointment, to identify the cause and shape a clear treatment plan.
Pelvic examination
Transvaginal pelvic ultrasound, to measure the womb lining
Endometrial biopsy where the lining is thickened
Hysteroscopy when needed for direct visualisation
Treatment
Treatment is built around your symptoms, preferences and any other conditions. Options often combine medication, hormonal treatments and where appropriate, surgery.
Vaginal oestrogen for thinning of the lining (atrophy), the most common cause
Removal of polyps (often hysteroscopically)
Treatment of endometrial hyperplasia, usually with progestogens or the Mirena coil
Adjustment of HRT if this is the cause
Onward referral if endometrial cancer is suspected
Related procedures
Diagnostic & operative
A short procedure that lets us look directly inside the womb using a slim camera. No cuts are needed. Available in clinic under local anaesthetic, or at hospital under general anaesthetic for more involved cases.
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Outpatient sample
A small sample of the womb lining, taken in clinic, to investigate heavy or abnormal bleeding. Quick to perform and usually well tolerated.
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Hysteroscopic surgery
Hospital removal of endometrial polyps using hysteroscopy, often with the MyoSure tissue-removal system. A short, scar-free procedure that's effective in a single visit.
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Your consultation
A first appointment is unhurried. We work through your history, your symptoms and your priorities, and where helpful arrange examination, imaging or further tests at the same visit. You leave with a clear plan and time to ask any question you bring.