Postmenopausal Bleeding

Postmenopausal bleeding (PMB) refers to any vaginal bleeding that occurs after menopause, which is defined as the point of a woman's last menstrual period, typically occurring around the age of 45-55. PMB is a common symptom that affects up to 20% of postmenopausal women.

Causes

• Hormone replacement therapy (HRT): HRT is a common cause of PMB, as it can stimulate the growth of the endometrium, leading to bleeding.
• Endometrial atrophy: Thinning of the endometrium, which can cause bleeding due to fragility and breakdown of the tissue.
• Endometrial polyps: Growths in the lining of the uterus that can cause bleeding.
• Uterine fibroids: Non-cancerous growths in the uterus that can cause bleeding.
• Endometrial hyperplasia: Thickening of the endometrium, which can increase the risk of cancer and cause bleeding.
• Endometrial cancer: Cancer of the lining of the uterus, which can cause bleeding.
• Cervical polyps: Growths on the cervix that can cause bleeding.
• Vaginal atrophy: Thinning and drying of the vaginal walls, which can cause bleeding.

Risk Factors

• Age: The risk of PMB increases with age.
• Obesity: Being overweight or obese increases the risk of PMB.
• Hormone replacement therapy (HRT): Women taking HRT are at increased risk of PMB.
• Family history of endometrial cancer: Women with a family history of endometrial cancer are at increased risk of PMB.

Symptoms

• Vaginal bleeding: The primary symptom of PMB, which can range from light spotting to heavy bleeding.
• Abnormal vaginal discharge: Women with PMB may experience abnormal vaginal discharge or odor.
• Pelvic pain: Some women with PMB may experience pelvic pain or discomfort.

Diagnosis

Diagnosis of PMB typically involves a combination of the following tests and procedures:

• Pelvic exam: A physical examination of the vagina, cervix, and uterus to check for any abnormalities.
• Ultrasound: An imaging test that uses sound waves to create images of the uterus and ovaries.
• Endometrial biopsy: A procedure in which a sample of tissue is taken from the lining of the uterus for examination under a microscope.
• Pap test: A screening test for cervical cancer that involves collecting cells from the cervix.

Treatment

Treatment of PMB depends on the underlying cause and may involve:

• Hormone replacement therapy (HRT) adjustment: Adjusting or stopping HRT to reduce bleeding.
• Medications: Prescribing medications such as progesterone or estrogen to control bleeding.
• Surgery: Performing surgery to remove polyps, fibroids, or other growths that may be causing bleeding.
• Endometrial ablation: A procedure in which the lining of the uterus is destroyed to reduce bleeding.

Prognosis

The prognosis for women with PMB depends on the underlying cause and the effectiveness of treatment. In general, women with PMB have a good prognosis if the underlying cause is identified and treated promptly.