What is post-menopausal bleeding? When the monthly periods stop for 12 months we call it menopause.  Any bleeding that happens after that is called post-menopausal bleeding.  Is it normal to have bleeding after menopause? It is never normal to have bleeding after menopause. Even if it is spotting, or slight smearing of blood on pad or happened only once or no pain it is still not normal and you should not ignore.  Is it cancer?  All women who have post-menopausal bleeding will not have cancer.  Only less than 10% women might have cancer. Rest of 90% might have simple reasons for bleeding.  What can be the reasons for the post-menopausal bleeding? Most common reason will be dryness of vagina also known as atrophy.  Other reasons might include small growths or polyps, infection of cervix or vagina, or use of hormone replacement pills. Less commonly there can be cancer of uterus or cervix or vagina.  What should I do when I notice post-menopausal bleeding?  Whenever you notice post-menopausal bleeding make an appointment with your doctor as soon as possible instead of postponing or observing for repetition.  What will happen at doctor’s visit?  When you visit the doctor will complaints of post-menopausal bleeding the doctor will take history of all your medical problems and check you which might involve internal check. If you are due for Pap smear or never had that done before Pap smear will be done which is twisting of soft brush at cervix – that is mouth of the uterus.  You will be advised ultrasound scan to check for any growths inside the uterus or abnormal thickness of uterine lining and also to rule out ovarian cysts.  You will be advised to have a biopsy of the lining of the uterus if it is looking thick. It is generally done in the outpatient department itself and you will not need anesthesia. It is well tolerated and a simple procedure. You might experience some crampy pain while biopsy is being taken.  The reports will be available in a week and you will be called to discuss the reports.  If biopsy is not tolerated or insufficient or if you are taking a pill for breast cancer you will need a camera test called hysteroscopy. A small camera is passed inside the uterus to check the lining. It can be done as outpatient or in operation theatre under anaesthesia. Even if you need anaesthesia it is a small procedure and you will be discharged on same day of the procedure.  What are the treatment options?  If biopsy and all examination reports are normal you will be reassured and no follow up will be needed unless the problem repeats. If there is uterine cancer identified you will need surgery to remove the uterus and ovaries. Remember the uterine cancers are detected early so there is very good cure possible. If vaginal dryness is the cause – you will be given hormone cream to help. If any infections identified you will be suggested appropriate antibiotics. If small polyps are the reason the polyps can be removed and sent for biopsy. If lining is thick but no cancer within then progesterone pills or coil will be suggested. Overall the treatment depends on the cause of the postmenopausal bleeding.