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.

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

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 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

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.

Office on Women’s Health http://www.womenshealth.gov

The Society of Obstetricians and Gynaecologists of Canada http://sogc.org/publications-resources/patient-fact-sheets

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
Updated May 2011. Accessed March 18, 2014.

Postmenopausal bleeding. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed
Updated May 17, 2012. Accessed March 18, 2014.

Sonohysterography. Radiological Society of North America Radiology Info website. Available at:
http://www.radiologyinfo.org/en/info.cfm?pg=hysterosono
Updated July 16, 2013. Accessed March 18, 2014.

11/5/2014 DynaMed’s Systematic Literature Surveillance
http://www.ebscohost.com/dynamed:
Khati NJ, Glanc P, et al. ACR Appropriateness Criteria abnormal vaginal bleeding [online publication]. Reston (VA: American College of Radiology (ACR); 2014. 13 p. Available at: https://acsearch.acr.org/docs/69458/Narrative. Accessed November 5, 2014.