Postmenopausal Bleeding

Overview

Definition

Postmenopausal bleeding (PMB) is bleeding from the vagina that happens after a woman has stopped having regular menstrual periods because of menopause. Any vaginal bleeding that occurs 12 months after a woman’s last menstrual period is considered PMB.

Female Reproductive Organs
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Causes

PMB may be caused by several factors. These may include:

  • Continuous hormone replacement therapy (HRT)
  • Thinning and loss of elasticity of the vagina
  • Inflammation of the endometrium, the lining of the uterus
  • Endometrial hyperplasia, a thickening of endometrium
  • Polyps, noncancerous growths on the uterus or cervix
  • Infection of the uterus or cervix
  • Uterine cancer
  • Cervical cancer
  • Fibroid tumors in the uterus or vagina

Risk Factors

Some medical conditions and medications you take can increase your chances of having PMB.

SymptomsandDiagnosis

Symptoms

Vaginal bleeding is a symptom of PMB. Your doctor can determine what condition is causing the bleeding and whether it is serious. If you have PMB, you should see your doctor.

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.

Tests will be done to find the cause of the bleeding. Tests may include:

  • Transvaginal ultrasound
  • Saline infusion sonohysterography
  • Hysteroscopy
  • MRI scan

Your doctor may need cell and tissue samples. This can be done with:

  • Cervical cancer screening
  • Endometrial biopsy

Treatments

Treatment

Talk with your doctor about the best treatment plan for you. The first priority is ruling out cancer. Treatment will depend on the findings of your tests and the cause of the bleeding. For instance, if your tests show signs of cancer, you will be referred to an oncologist, a doctor who specializes in treating cancer.

Prevention

There are no current guidelines to prevent PMB.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Edits to original content made by Denver Health.

a (Bleeding, Postmenopausal; PMB)

RESOURCES

Office on Women's Health https://www.womenshealth.gov 

The American Congress of Obstetricians and Gynecologists https://www.acog.org 

CANADIAN RESOURCES

Canadian Women's Health Network http://www.cwhn.ca 

Society of Obstetricians and Gynaecologists of Canada https://sogc.org 

References

American Congress of Obstetricians and Gynecologists. ACOG Committee Opinion No. 440: the role of transvaginal ultrasonography in evaluation of postmenopausal bleeding. Obstet Gynecol. 2009;114(2 Pt 1):409-411. Reaffirmed 2015.

Gale A, Dey P. Postmenopausal bleeding. Menopause Int. 2009;15(4):160-164.

Perimenopausal bleeding and bleeding after menopause. The American College of Obstetricians and Gynecologists website. Available at: https://www.acog.org/~/media/For%20Patients/faq162.pdf?dmc=1&ts=20121221T1430328285. Updated May 2011. Accessed April 16, 2018.

Postmenopausal bleeding. EBSCO DynaMed Plus website. Available at:  http://www.dynamed.com/topics/dmp~AN~T116214/Postmenopausal-bleeding . Updated June 19, 2014. Accessed April 16, 2018.

Sonohysterography. Radiology Info—Radiological Society of North America website. Available at: https://www.radiologyinfo.org/en/info.cfm?pg=hysterosono. Updated February 25, 2018. Accessed March 14, 2016.

11/5/2014 DynaMed's Systematic Literature Surveillance  http://www.dynamed.com/topics/dmp~AN~T116214/Postmenopausal-bleeding : Khati NJ, Glanc P, Priyadarshani R, et al. ACR Appropriateness Criteria abnormal vaginal bleeding. Available at: https://acsearch.acr.org/docs/69458/Narrative. Updated 2014.