The most important thing is understanding why you may need a procedure.  And what we are looking for.

Abnormal vaginal bleeding is any bleeding that is different from your normal period. This can include bleeding between periods, very heavy periods, or bleeding after sex. For women who have gone through menopause, any bleeding is not normal. It is important to pay attention to abnormal bleeding because it can sometimes be a sign of health problems that need treatment, such as changes in hormones or even cancer of the womb lining.

Abnormal bleeding is common perimenopause

Abnormal bleeding is common during perimenopause, the time leading up to menopause, because of changes in hormone levels. Hormones like estrogen and progesterone can go up and down a lot, which can cause your periods to become irregular, happen more often, or be heavier than usual. These changes in hormones can cause the lining of the womb to grow and shed unevenly, leading to abnormal bleeding.  Even though worrying conditions like endometrial cancer are not common in the perimenopause they can still occur, and are very treatable which is why we take abnormal bleeding seriously.

Why Abnormal Bleeding Happens in Postmenopause

For women who have gone through menopause, any vaginal bleeding is not normal and should be checked by a doctor. This bleeding can happen due to thinning of the lining of the womb, growths like polyps, or sometimes because of hormone treatments. In some cases, bleeding after menopause can be a sign of something more serious, like cancer of the womb lining.

Risk of Cancer with Postmenopausal Bleeding

Approximately 10% of women experience postmenopausal bleeding, but among those who do, only about 1-2% are diagnosed with endometrial cancer. Most causes of postmenopausal bleeding are benign, such as thinning of the uterine lining or benign growths like polyps. However, because postmenopausal bleeding can still be a sign of endometrial cancer, it is important for any bleeding after menopause to be evaluated by a healthcare provider. 

Hormone Replacement Therapy (HRT) and Abnormal Bleeding

Changes in HRT, including adjustments in dose, can cause vaginal bleeding. It is common to experience bleeding within the first 3 months of a change, and this can occur frequently within the first 6 months. However, if bleeding continues after 6 months, it should be investigated to rule out any serious underlying causes.

At FemaleGP, we don’t routinely recommend stopping your HRT while we investigate the bleeding, as HRT provides important benefits for managing menopausal symptoms. In some cases, we may suggest adjusting the HRT dose to help reduce the bleeding.

A Pipelle biopsy is performed to obtain a small sample of the lining of the uterus (endometrium) to check for abnormal cells, polyps, or other conditions. It is commonly used to investigate abnormal uterine bleeding, assess the endometrium in postmenopausal women, or monitor hormone therapy.

The cells removed from the womb are then sent to the lab to be examined under the microscope.  

I will give you the opportunity to receive back your sample, as we understand that this is part of you.

The procedure is done in the FemaleGP Clinic in Napier and you are booked for 20-30 minutes.  It is quick and usually takes only a few minutes (most of the time is taken up getting to know you and setting up to ensure you are in the right position!). 

The procedure can be quite crampy, similar to severe menstrual pain, so we advise you to take a pain reliever, such as ibuprofen, about 30-60 minutes before the procedure to help reduce discomfort.  The procedure can be done if are menstruating or have vaginal bleeding, and also if you have a Mirena/IUD in situ already. 

You may wish to bring a support person with you. They can wait outside or be in the procedure room with you. You may also want to bring some headphones. You can eat and drink beforehand. Afterward, you should be good to go home straight away, but be aware that you are unlikely to feel like rushing.

During the procedure, you will lie on a (pink) examination table with your feet in stirrups.  If your support person is present they are positioned facing your head, to maintain your privacy.  First of all your blood pressure is taken, then an examination of your abdomen, and then a vaginal examination to assess the position and size of your uterus (womb).  A speculum will be inserted into the vagina to allow access to the cervix, and a thin tube called the Pipelle will be passed through the cervix into the uterus to collect a tissue sample. 

This step may cause cramping or discomfort similar to menstrual cramps.  While generally manageable, some individuals may find it more uncomfortable.  If your body finds it too much then as you are always in control we stop.    To help reduce discomfort, focus on deep breathing and relaxing your pelvic muscles throughout the procedure.  We will support you through the procedure.

Like any procedure, a Pipelle biopsy comes with some risks, but overall, it is very safe. The most common side effects include pain, similar to menstrual cramps, and light bleeding. Rarely, more serious complications can occur, such as uterine perforation (occurring in less than 1 in 1,000 cases) or heavy bleeding and infection (occurring in about 1 in 300 cases). In some instances, the procedure may be unsuccessful due to inability to access the uterine cavity, which happens occasionally but is generally manageable.

Fundamentally, we always review why we are doing it, and ensure that the benefits outweigh the risks.

We will send you some information about the appointment, and you can contact us if you have any questions.

The procedure can be quite crampy, similar to severe menstrual pain, so we advise you to take a pain reliever, such as ibuprofen, about 30-60 minutes before the procedure to help reduce discomfort.

The procedure can be done if are menstruating or have vaginal bleeding, and also if you have a Mirena/IUD in situ already. 

You may wish to bring a support person with you. They can wait outside or be in the procedure room with you. You may also want to bring some headphones. You can eat and drink beforehand. Afterward, you should be good to go home straight away, but be aware that you are unlikely to feel like rushing.

For those who like to know a bit more: ibuprofen also helps the cervix (neck of the womb) open, making the procedure easier. The procedure is crampy because the womb is a muscle and is cramping down on the pipelle. 

After a Pipelle procedure, it is normal to experience light bleeding or spotting, and you may have some mild cramping or discomfort, similar to period pain. We have pads available for you to use after the procedure.

To help manage any pain, you can take over-the-counter pain relief, such as ibuprofen or acetaminophen, and rest as needed. Using a heating pad on your lower abdomen may also help alleviate cramping.

If you have severe, or worsening pain, heavy bleeding or abnormal discharge these are signs that you may have an infection so we recommend you seek medical attention

The results from your Pipelle sample usually take 1-2 weeks. You will be able to access your results through the FemaleGP portal, and we will follow up on the results and inform your GP. If you continue to have bleeding, even if the sample is normal, we recommend that you see your GP or return to us for a follow-up, as you may still need a referral to a gynecologist.