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Postmenopausal Bleeding
Aka: Postmenopausal Bleeding, Post-menopausal Bleeding, Uterine Bleeding after Menopause- See Also
- Abnormal Uterine Bleeding (Dysfunctional Uterine Bleeding)
- Endometrial Cancer Screening
- Menopause
- Menstrual Cycle
- Abnormal Uterine Bleeding Causes
- Anovulatory Bleeding (Metrorrhagia)
- Ovulatory Bleeding (Menorrhagia)
- Uterine Bleeding in Pregnancy
- First Trimester Bleeding
- Late Pregnancy Bleeding
- Oral Contraceptive-Related Uterine Bleeding Management
- Postmenopausal Bleeding
- Amenorrhea
- Lower GI Bleed
- Hematuria
- Causes
- See Abnormal Uterine Bleeding Causes
- Extra-uterine source
- 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
- Indications: Evaluation for Postmenopausal Bleeding
- Postmenopause without Hormone Replacement
- Postmenopause on Hormone Replacement >6 months
- Evaluation
- See Endometrial Cancer Screening
- Careful exam of external genitalia as well as speculum exam
- Catheterized Urinalysis
- Rectal exam
- Imaging
- Transvaginal Ultrasound
- Determine endometrial thickness (5 mm)
- Evaluate for other uterine and Adnexal anomalies
- Transvaginal Ultrasound
- Management
- References
- Apgar (2003) AAFP Board Review, Seattle