Postmenopausal bleeding
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PATIENT INFORMATION
Postmenopausal Bleeding (PMB)
What is postmenopausal bleeding (PMB)?
Postmenopausal bleeding refers to vaginal bleeding that occurs after 12 months of no menstrual periods in a woman who is not on hormone therapy. It is considered abnormal and requires medical evaluation.
What causes PMB?
Common causes include:
– Atrophic vaginitis: Thinning and inflammation of the vaginal walls due to decreased estrogen levels.
– Endometrial hyperplasia: Thickening of the uterine lining, often caused by hormonal imbalances.
– Polyps: Benign growths in the uterus or cervix.
– Endometrial cancer: Although rare, PMB can be an early sign of endometrial cancer, which affects approximately 10% of women with PMB.
– Other causes: Hormone therapy, infections, or trauma.
How is PMB diagnosed?
Diagnosis involves:
– A detailed medical history and physical examination.
– A pelvic ultrasound to assess the uterus and ovaries.
– Endometrial biopsy to rule out cancer or other abnormalities.
– Blood tests to check hormone levels or other markers.
What are the treatment options for PMB?
Treatment depends on the underlying cause:
– Atrophic vaginitis: Vaginal estrogen creams or moisturizers.
– Polyps: Removal through minimally invasive procedures.
– Endometrial hyperplasia: Hormonal therapy or surgical intervention.
– Cancer: Referral to a specialist for further management.
What do Australian guidelines recommend?
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) emphasizes:
– Prompt evaluation of all cases of PMB to rule out malignancy.
– Use of transvaginal ultrasound as the first-line imaging tool.
– Endometrial biopsy for women with abnormal ultrasound findings or risk factors for endometrial cancer.
When should I see a doctor?
You should consult a healthcare provider if you experience any vaginal bleeding after menopause, even if it is light or intermittent. Early diagnosis and treatment can prevent complications.