Post-menopausal bleeding

​​​​​​Emergency

If any of the following are suspected, seek emergency medical advice or refer the patient to the emergency department (via ambulance if necessary)

  • ​Uncontrolled vaginal bleeding or haemodynamic instability

When public outpatient services are not routinely provided

  • Expected, regular withdrawal bleed in patient taking cyclical menopausal hormonal therapy (MHT)
  • < 12 months since last menstrual period
    Note: refer to abnormal uterine bleeding SRC for more information
  • Single episode of bleeding with endometrial thickness < 4 mm on ultrasound and negative cervical screening result​

Criteria to access public outpatient services

CategoryCriteria
Category 1
Recommended to be seen within 30 calendar days.
  • Heavy, post-menopausal bleeding in females who have had a hysterectomy for cervical dysplasia and genital tract malignancy
  • Post-menopausal bleeding with any of the following features:
    • Any endometrial thickness with cystic spaces
    • Endometrial thickness > 4 mm on ultrasound
    • Focal endometrial lesion
    • Suspicion of malignancy on ultrasound​
​Category 2
Recommended to be seen within 90 calendar days.
  • ​≥ 12 months since last menstrual period and > 6 months since starting continuous combined menopausal hormonal therapy (CCMHT) where endometrial thickness < 4 mm on ultrasound
  • Post-menopausal bleeding with any of the following features:
    • Abnormal cervical screening co-test
    • Cervical polyps
    • Recurrent bleeding regardless of endometrial thickness

Category 3
Recommended to be seen within 365 calendar days.

  • ​Females who have had a hysterectomy for benign gynaecological conditions​

Information to include within a referral

Required​

  • Reason for referral
  • Details of the presenting condition, including symptoms and their duration
  • Provisional diagnosis
  • Patient health summary (such as relevant medical history, relevant investigations, current medications and dosages, immunisations, allergies and/or adverse reactions), including specifically:
    • Transvaginal ultrasound results
    • Cervical co-test (preferred)
    • History of menopausal hormone therapy (MHT) or Tamoxifen use​

If available

  • Full blood count and ferritin (if significant bleeding)
  • Body mass index
  • Sexually transmitted infection (STI) test results​

Important information for referring health professionals

If there is a change to a patient’s condition while waiting for their appointment, referring health professionals may further investigate and manage the situation, or send an updated referral to the outpatient service. Where there are significant concerns about a patient's condition, referring health professionals may check HealthPathways for urgent/same day advice or contact the relevant clinical team.

Current as at: Monday 23 March 2026
Contact page owner: System Purchasing