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Postmenopausal Bleeding by Sarah J. Kerr, BA

Definition

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

PMB should always be reported to a doctor. In most cases, it is not serious. In others, it can be the first sign of a serious disease.

Female Reproductive Organs

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
Endometrial 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.

Symptoms

The most common indication of PMB is vaginal bleeding.

PMB is a symptom of another condition. 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

Your doctor will ask about your symptoms and medical history. A physical exam will be done.

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

Transvaginal ultrasound
Saline infusion sonohysterography
Hysteroscopy

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

Cervical cancer screening
Endometrial biopsy

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, your doctor will refer you to an oncologist, a doctor who specializes in treating cancer.

Prevention

PMB cannot be prevented.

RESOURCES:

American Congress of Obstetricians and Gynecologists http://www.acog.org
US Department of Health and Human Services Womens Health http://www.womenshealth.gov

CANADIAN RESOURCES:

Health Canada http://www.hc-sc.gc.ca
The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org

References:

American College of Obstetricians and Gynecologists (ACOG) Committee Opinion on role of transvaginal ultrasonography in evaluation of postmenopausal bleeding. Obstet Gynecol. 2009;113(2):462.
Gale A, Dey P. Postmenopausal bleeding. Menopause Int. 2009;15(4):160-164.
Perimenopausal bleeding and bleeding after menopause. American Congress of Obstetricians and Gynecologists website. Available at: http://www.acog.org/~/media/For%20Patients/faq162.pdf?dmc=1&ts=20121221T1430328285. Accessed April 22, 2013.
Postmenopausal bleeding. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated May 17, 2012. Accessed April 22, 2013.
Sonohysterography. American College of Radiology Radiology Info website. Available at: http://www.radiologyinfo.org/en/info.cfm?pg=hysterosono. Updated March 7, 2013. Accessed April 22, 2013.

Last reviewed April 2013 by Andrea Chisholm, MD; Brian Randall, MD

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