Any bleeding after the menopause needs investigating — however light, however brief, however long ago.
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Womb cancer is the most common gynaecological cancer in the UK, and unusually among cancers it tends to announce itself early.
The overwhelming majority of cases cause abnormal bleeding — which means that acting on that one symptom catches most cases at a stage where treatment works very well.
Any bleeding after the menopause needs investigating. However light. However brief. Even if it happened once, months ago, and never again.
Most postmenopausal bleeding turns out not to be cancer — a thinned womb lining, polyps and HRT effects are all commoner. But it is the symptom that finds the cases that matter, and it should never be watched and waited on.
We cannot examine you, and this needs examination and an ultrasound. Your NHS GP can arrange both and refer urgently.
What we can do is make sure the symptom is taken seriously, and write to them the same day.
Some bleeding patterns on HRT are expected, and some are not — and the difference matters.
Unscheduled bleeding on HRT, or bleeding that starts after a settled period on it, should be assessed rather than assumed to be the treatment. That is a common source of delay.
Atrophic changes from low oestrogen, polyps, fibroids and HRT effects are all far commoner causes of abnormal bleeding.
Which is a reason to get it checked promptly, not a reason to wait.
Most womb cancers are driven by oestrogen acting on the womb lining without progesterone to balance it. That single mechanism explains most of the risk factors.
The combined pill and the hormonal coil both reduce womb cancer risk, and the protection persists.
Weight loss reduces it too, which is one of the clearer examples of a modifiable cancer risk.
Lynch syndrome raises the risk of both bowel and womb cancer. Where several relatives have been affected, or anyone was diagnosed young, NHS genetic assessment is free and worth asking about.
A transvaginal ultrasound measures the thickness of the womb lining. In a postmenopausal woman, a thin lining makes cancer very unlikely and often ends the investigation there.
You can decline a transvaginal scan and ask for an abdominal one, with the caveat that the views are less detailed. You can also ask for a chaperone — that is your right.
An endometrial biopsy — a thin sampling tube passed through the cervix, usually in an outpatient clinic. It takes a few minutes and can cause period-type cramping.
Take painkillers an hour beforehand, and say if it is painful — it should not simply be endured, and there are options.
Hysteroscopy, a camera examination of the womb cavity, follows where biopsy is inconclusive or polyps are suspected.
Cervical screening does not detect womb cancer. It samples the cervix only, and a normal recent smear says nothing about the womb lining.
And no blood test screens for it. CA-125 is not a test for womb cancer.
We cannot examine you or arrange the internal ultrasound that this needs. We do not diagnose or treat womb cancer.
Postmenopausal bleeding needs your NHS GP, who can examine you and refer urgently — free, and usually within two weeks.
Do not wait for a private appointment to act on postmenopausal bleeding. Contact your NHS GP today. We would tell you the same thing at the start of a consultation.
Ask specifically for an urgent gynaecology referral and an ultrasound.
"It is probably just dryness" or "it is your age" are not assessments. Postmenopausal bleeding warrants a scan.
And "your smear was normal" does not answer this question — cervical screening does not look at the womb.
Weight is the largest modifiable risk factor for womb cancer, and the relationship is stronger here than for most cancers — fat tissue produces oestrogen, which drives the womb lining.
Losing weight reduces risk, which makes this one of the few places where the advice is both specific and evidenced.
If you have a womb, your HRT should include progesterone. Oestrogen alone raises womb cancer risk substantially in that situation.
This is standard practice and rarely goes wrong — but it is worth knowing, particularly if you have ever sourced HRT outside regulated prescribing, where unopposed oestrogen does turn up.
If you take one thing from this page: any bleeding after the menopause gets checked.
That single rule catches most womb cancers early, which is why outcomes for this cancer are comparatively good.
Womb cancer has one clear warning sign, and acting on it is what determines the outcome: any bleeding after the menopause. Not heavy bleeding, not repeated bleeding — any bleeding, even once, even spotting.
That symptom triggers an urgent NHS two-week-wait referral, free, usually to a one-stop clinic with ultrasound and, where needed, a biopsy on the same visit. Womb cancer is frequently caught early precisely because it bleeds early, and outcomes when caught early are good.
There is no screening test for womb cancer, and none is recommended. A cervical smear does not detect it — a point that causes real harm, because women with postmenopausal bleeding sometimes wait, reasoning that their smear was normal.
What we can genuinely do is write the urgent referral today, rather than the bleeding being attributed to atrophy or HRT and watched for a few months.
Where private care shortens things is a faster ultrasound or hysteroscopy if NHS waits locally are long — though the urgent cancer pathway is already fast.
The risk factors worth knowing — obesity in particular, which is the largest modifiable one, along with unopposed oestrogen, PCOS and tamoxifen — make bleeding more significant rather than less.
NICE NG12, Suspected cancer: recognition and referral, is the governing guideline. It recommends urgent referral for women aged 55 and over with post-menopausal bleeding, and consideration of referral in women under 55 with the same symptom.
NG12 also recommends direct-access ultrasound for women aged 55 and over with unexplained vaginal discharge or visible haematuria alongside other features.
There is no UK screening programme for endometrial cancer, and the UK National Screening Committee does not recommend one — the basis for the point above about smears.
RCOG and BGCS (British Gynaecological Cancer Society) guidelines cover investigation of postmenopausal bleeding, including transvaginal ultrasound endometrial thickness thresholds and hysteroscopy with biopsy.
The association with obesity, unopposed oestrogen, PCOS, diabetes and tamoxifen is documented in BGCS guidance and Cancer Research UK data, and underpins the risk factors named above.
Yes. A single episode of postmenopausal bleeding needs investigating even if it never recurred.
The fact that it stopped is not reassuring — that is exactly how early womb cancer often presents.
No — and this misunderstanding causes real delay.
Cervical screening samples the cervix only. It says nothing about the womb lining, and a recent normal smear does not explain abnormal bleeding.
Some patterns are, and some are not.
Unscheduled bleeding, or bleeding that starts after things had settled, should be assessed rather than assumed to be the HRT. It is a common reason investigation is delayed.
Properly prescribed HRT that includes progesterone does not raise the risk — the progesterone is there specifically to protect the womb lining.
Oestrogen alone, in a woman with a womb, does raise it substantially, which is why that combination is not used.
It gives much better views, but you can decline it.
Ask for an abdominal scan instead, understanding that the views are less detailed, and ask for a chaperone — that is your right and any unit will arrange it.
More than for most cancers, yes. Fat tissue produces oestrogen, which stimulates the womb lining, and risk rises steeply with weight.
It is one of the clearest examples of a cancer risk that responds to something you can change.
It can cause period-type cramping, and for some women it is genuinely uncomfortable.
Take painkillers an hour beforehand, and say if it hurts. There are options including a different setting or anaesthetic — it should not simply be endured in silence.
It can be. Lynch syndrome raises the risk of both bowel and womb cancer, and it is under-recognised.
Where several relatives are affected, or anyone was diagnosed young, ask your GP about NHS genetic assessment — it is free and it changes what monitoring you are offered.
August 30, 2026
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