• Postmenopausal Bleeding

    (Bleeding, Postmenopausal; PMB)

    Definition

    Postmenopausal bleeding (PMB) is bleeding from the vagina that happens after a woman has stopped having regular menstrual periods due to menopause . A woman is considered to be in menopause if it has been 12 months since her last menstrual period. This usually occurs between 40 and 58 years of age. 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. Often, the cause is not serious. However, PMB may sometimes be the first sign of a serious disease, such as uterine cancer .
    Female Reproductive Organs
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    Causes

    PMB may be caused by several factors. These include:
    • Continuous hormone replacement therapy (HRT) —a low dose of estrogen and progesterone taken daily to treat menopause symptoms (Bleeding or spotting is common during the first year of HRT.)
    • Atrophy of the vagina—thinning and loss of elasticity of the vagina
    • Atrophic endometriosis—inflammation of the endometrium (lining of the uterus)
    • Endometrial hyperplasia—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

    Having a condition or taking a medicine that can cause PMB increases your risk for having PMB.

    Symptoms

    Most people will notice blood coming out of the vagina.
    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.
    Some conditions may be confused with PMB, such as:
    • Hematuria —blood in the urine
    • Bleeding from the rectum

    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.
    Your doctor may need to view your pelvic organs. This can be done with:
    • Speculum exam
    • 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 uterine 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/For%5FPatients

    WomensHealth.gov 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 December 21, 2012.

    Postmenopausal bleeding. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated May 17, 2012. Accessed December 21, 2012.

    Scottish Intercollegiate Guidelines Network (SIGN). Investigation of post-menopausal bleeding: a national clinical guideline. SIGN . 2002 Sep.

    Sonohysterography. RadiologyInfo.org website. Available at: http://www.radiologyinfo.org/en/info.cfm?pg=hysterosono . Updated April 24, 2012. Accessed December 21, 2012.

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