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.
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PMB may be caused by several factors. These may include: Continuous hormone replacement therapy (HRT)Thinning and loss of elasticity of the vaginaInflammation of the endometrium, the lining of the uterusEndometrial hyperplasia, a thickening of endometriumPolyps, noncancerous growths on the uterus or cervixInfection of the uterus or cervixEndometrial cancerCervical cancerFibroid tumors
in the uterus or vagina
Some medical conditions and medications you take can increase your chances of having PMB.
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.
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 ultrasoundSaline infusion sonohysterographyHysteroscopy
Your doctor may need cell and tissue samples. This can be done with: Cervical cancer screeningEndometrial biopsy
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.
SexualityandU.ca - The Society of Obstetricians and Gynaecologists of Canada
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 June 2013 by Andrea Chisholm, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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