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.
Female Reproductive Organs
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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.
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.
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 ultrasoundSaline infusion sonohysterographyHysteroscopyMRI scan
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, you will be referred to an oncologist, a doctor who specializes in treating cancer.
There are no current guidelines to prevent PMB.
American Congress 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. 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.
Last reviewed January 2015 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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