II. Causes
- See Abnormal Uterine Bleeding Causes
- Extra-uterine source
- Cervical, vaginal, vulvar and Adnexal bleeding
- Hematuria (Urethra, Bladder, ureter or Kidney)
- Lower Gastrointestinal Bleeding (e.g. Rectal Bleeding)
- Evaluate for Malignancy!
- Postmenopausal Bleeding is due to malignancy (esp Endometrial Cancer) in up to 40% of cases
- Peak Incidence of Endometrial Cancer is age 60-64 years
-
Atrophic Vaginitis
- Most common cause of Postmenopausal Bleeding
- Postmenopausal Endometrial Hyperplasia
- If no Estrogen Replacement, find Estrogen source
III. Indications: Evaluation for Postmenopausal Bleeding
- Postmenopause without Hormone Replacement
- Postmenopause on Hormone Replacement >6 months
IV. Evaluation
- See Endometrial Cancer Screening
- Careful exam of external genitalia as well as speculum exam
- Catheterized Urinalysis
- Rectal Exam
V. Imaging
-
Transvaginal Ultrasound
- Determine endometrial thickness (5 mm)
- Evaluate for other uterine and Adnexal anomalies
VI. Management
VII. References
- Apgar (2003) AAFP Board Review, Seattle