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Women who experience vaginal blood loss during menopause will visit their GP due to menstruation when they are no longer supposed to be menstruating (post-menopausal).

Here are 5 key questions your GP will ask you before referring you to a specialist

  1. Is the blood loss only from your vagina? You might find this an awkward question, but this is to make sure to rule out any rectal blood loss which could look and feel like blood coming from the vagina. Especially if the woman is known to have haemorrhoids, it is a topic that your GP will want to briefly touch on and move on to the next question
  2. The 3 How’s: How does the vaginal blood loss occur, how often does it occur a day/week and how long does it last for. 
  3. Does vaginal blood loss occur after sexual intercourse. If this is the case, the GP will need to determine whether it is a cervical polyp or the lining of the vagina that is wearing thin and after friction bleeds easily. This is also known as vaginal atrophy. 
  4. Do you use any medication?
  5. Could you possibly be at risk of a sexually transmitted disease? May sound strange that your GP asks you this for vaginal blood loss, however diseases like chlamydia can cause similar symptoms. 

Things you must ask your GP during your consultation.

What are the changes that even after I have been referred to a specialist, I will be sent back to my GP for further treatment? 

50% of the women who have post menopausal blood loss and are referred to a specialist do not have any serious underlying medical condition. In the majority of the cases, the blood loss is due to vaginal atrophy. 

Do I have endometrial cancer with these symptoms?

Endometrial cancer is known to cause post menopausal blood loss. It occurs in about 2000 women per year in the Netherlands and of these 20% (400 women) will unfortunately die from this disease. In the majority of cases, when endometrial cancer is screened and treated early, just over 90% of women will make a full recovery.

Should my GP perform a PAP smear even if I’ve had one just recently?

Yes. For any woman with new onset of post menopausal blood loss regardless of the results of an old PAP smear, a new one must be requested. This is because it is important to rule out a cervical tumor. If a PAP smear is performed and the results are negative, then the GP will not need to refer you to a specialist. However if the laboratory finds slightly abnormal cells, they will proceed with further testing.

Your GP may decide to refer you for an ultrasound of your uterus and ovaries. 

How certain am I that an ultrasound will accurately determine I do not have cancer? 

A negative ultrasound has a strong predictive value, meaning if the ultrasound of the thickness of your uterus is small, then you can be 99% sure you do not have endometrial cancer. 

So in summary for new onset post menopausal vaginal blood loss your GP will request a PAP smear and/or transvaginal ultrasound. Once these results are known, then a decision will be made whether to refer you to a specialist. 

What if the vaginal blood loss returns despite the previous ‘ negative ‘ results? should I then get a referral? 

Absolutely! Early screening is very important, and if you develop a recurrence of vaginal blood loss, your GP should refer you immediately to a specialist for further work-up such as histology.