Menses

Postmenopausal Bleeding

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Postmenopausal Bleeding, Post-menopausal Bleeding, Uterine Bleeding after Menopause

  • Causes
  1. See Abnormal Uterine Bleeding Causes
  2. Extra-uterine source
    1. Cervical, vaginal, vulvar and Adnexal bleeding
    2. Hematuria (Urethra, Bladder, ureter or Kidney)
    3. Lower Gastrointestinal Bleeding (e.g. rectal bleeding)
  3. Evaluate for Malignancy!
    1. Postmenopausal Bleeding is due to malignancy (esp Endometrial Cancer) in up to 40% of cases
    2. Peak Incidence of Endometrial Cancer is age 60-64 years
  4. Atrophic Vaginitis
    1. Most common cause of Postmenopausal Bleeding
  5. Postmenopausal Endometrial Hyperplasia
    1. If no Estrogen Replacement, find Estrogen source
  • Indications
  • Evaluation for Postmenopausal Bleeding
  • Evaluation
  1. See Endometrial Cancer Screening
  2. Careful exam of external genitalia as well as speculum exam
  3. Catheterized Urinalysis
  4. Rectal exam
  • Imaging
  1. Transvaginal Ultrasound
    1. Determine endometrial thickness (5 mm)
    2. Evaluate for other uterine and Adnexal anomalies
  • References
  1. Apgar (2003) AAFP Board Review, Seattle