Post menopausal bleeding


·         An episode of bleeding 12 months or more after the last period.

2ww referral

·         If endometrial cancer is suspected, refer on 2ww:

o   Post-menopausal bleeding (PMB) >55y

o   Patients under 55 yrs with PMB should only be referred by 2ww where they also have high risk factors such as obesity/high BMI, are on Tamoxifen, or suffering from recurrent PMB

Refer to PMB clinic not 2ww

·         Women <55y without risk factors

·         Women with abnormal bleeding using sequential HRT if:

·                   Bleeding is heavy or prolonged at the end of or after the progestogen phase

·         ·         Or bleeding occurs at any time (breakthrough bleeding).

·         Women with bleeding on continuous combined regimens if:

·         ·         It occurs after the first 6 months of treatment, or

·         ·         It occurs after amenorrhoea has been established

·         Women with recurrence of PMB should be considered 6 months after investigation

·         Post-menopausal women presenting with post-coital bleeding

Referral form here


Reference: Investigation of post-menopausal bleeding SIGN Publication No.61, Sept 2002