Postmenopausal Bleeding | Dr N Layyous

Postmenopausal Bleeding

Menopause is when the menstrual cycle stops, and 12 months pass without having menstrual periods. And this usually happens in women in their 40s and 50s.

The final cycles can be irregular or heavy and this may last for 5 years of which we call premenopause.

Any vaginal bleeding, cycle like blood or spotting after menopause is called postmenopausal bleeding (PMB).

Bleeding after menopause is usually a sign of a minor problem but can sometimes be an early sign of a serious disease, so it should be taken seriously as cancer until proven otherwise.

When detected early, most conditions (including malignancies) can usually be successfully treated.

Causes of Postmenopausal Bleeding

• Inflammation and thinning of the vaginal tissue (called atrophic vaginitis)
• Thinning of the endometrium.
• Benign polyps in the cervix or the uterus.
• Thick endometrium (called endometrial hyperplasia) most of the time caused by hormone replacement therapy (HRT)
• In about 10 per cent of cases, post-menopausal bleeding is related to cancer of the cervix or uterus.

Risk Factors of endometrial cancer

It is very important to realize the causes that may put some women in danger of having endometrial cancer which is a serious cause of postmenopausal bleeding

• Diabetic patients
• Hypertension
• Null parity, having no children
• History of Polycystic ovary syndrome
• Obesity
• Taking unopposed estrogen hormone replacement therapy
• Receiving Tamoxifen as a treatment for breast cancer
• Family history of gastrointestinal and genitourinary cancers like ovarian and endometrial cancers and colon cancer especially at young ages
• Usually in women above 60 years of age

Management of Postmenopausal Bleeding

In women with Postmenopausal bleeding good history, examination and investigations must be done

At first Referral to a Gynecologist

• History about any medical problems like diabetes, hypertension, polycystic ovaries, thrombosis renal diseases, endocrine or cardiac diseases.
• History of cancers in family and patient.
• History of marriage, sexual life, pregnancies and deliveries.
• History of taking any medications like anticoagulants or hormones.
• Examination of vital signs, breast masses, abdominal masses, cervical or vaginal masses or abnormalities through an internal examination using speculum.
• Investigations full blood count, thyroid function, Pap smear and vaginal ultrasound scanning.

Treatment Options for Postmenopausal Bleeding

The kind of treatment depends on the cause of bleeding.

• Thinning of the endometrium or vagina is treated by estrogen hormone orally or cream.
• Polyps are usually removed by hysteroscopy and dilation and curettage under general anesthesia

• Thickening of the endometrium is usually treated with dilation and curettage and sending tissues for histopathology.
• After ruling out malignancies treatment can be by hormones like progesterone either orally or through an intra uterine device Mirena.
• Hysterectomy total or subtotal is a definite treatment.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist