Postmenopausal Bleeding

Overview

Definition

Postmenopausal bleeding (PMB) is vaginal bleeding that happens 12 months after a woman’s last menstrual period or in women taking hormone replacement therapy (HRT).

Female Reproductive Organs
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Causes

Some causes are:

  • Continuous HRT
  • Changes in the endometrial lining of the uterus
  • Loss of vaginal elasticity
  • Noncancerous growths on the uterus or cervix
  • Infection of the uterus or cervix
  • Uterine orcervical cancer
  • Fibroid tumors in the uterus or vagina

Risk Factors

Some health problems and medicines can raise the risk of this problem.

SymptomsandDiagnosis

Symptoms

Vaginal bleeding is a symptom of PMB.

Diagnosis

You will be asked about your symptoms and health history. A physical exam will be done. It will include a pelvic exam.

The pelvic organs will need to be viewed. This can be done with:

  • Transvaginal ultrasound
  • Hysteroscopy
  • Saline infusion sonohysterography

Cell and tissue samples will be needed for testing. This can be done with:

  • Endometrial biopsy
  • Cervical cancer screening

Treatments

Treatment

Treatment will depend on the cause of the bleeding.

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

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

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

CANADIAN RESOURCES

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

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

References

Perimenopausal bleeding and bleeding after menopause. The American College of Obstetricians and Gynecologists website. Available at: https://www.acog.org/patient-resources/faqs/gynecologic-problems/perimenopausal-bleeding-and-bleeding-after-menopause. Updated November 2018. Accessed July 22, 2020.

Postmenopausal bleeding. EBSCO DynaMed website. Available at:  https://www.dynamed.com/condition/postmenopausal-bleeding  . Updated February 18, 2019. Accessed July 22, 2020.

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 July 22, 2020.

Turnbull H, Glover A, et al. Investigation and management of abnormal peri-menopausal bleeding. Menopause Int. 2013 Dec;19(4):147-154.