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Postmenopausal bleeding is bleeding or spotting following menopause (i.e. confirmed 12 months after your last period).
Patient information What is postmenopausal bleeding?
It's bleeding after menopause.
It's when vaginal bleeding stops for 1 year. That's different from from how amenorrhea is defined, which is 3 months?
Endometriosis → womb tissue grows somewhere else Growth, including:
Exogenous estrogen (20%), e.g.
HRT Non-gynecological, including:
Bleeding from the urinary tract
Bleeding from the rectum
Patient information What causes bleeding after your periods have stopped for 1 year?
Thinning is a biggy, and that can be of the vagina, the vulva, or the womb's lining. Womb tissue can be growing where it shouldn't be. There could be a growth, like a polyp, fibroid, hyperplasia, or even cancer, and it can be of the vulva, vagina, cervix, womb, or endometrium. It can be exogenous estrogen. And it can be non-gyne stuff like trauma or some other bleeding.
Associated trauma → pelvic trauma
Weight loss → cancer
Use of HRT, type, duration
Tamoxifen → associated w/ changes to the endometrium, including polyps, hyperplasia and cancer
Especially those containing estrogen, including intake of soy
PMH of breast cancer
FH of cancers
BMI → risk factor for endometrial cancer
Abdominal palpation for discernable masses
Speculum exam, for:
Inspection of the vulva and vagina → atrophy, trauma, foreign body
Pap test (sample of cervix) → cervical cancer
Bimanual, evaluating uterine size
Vaginal swab → infection Transvaginal U/S, for increased endometrial thickness (>5mm) → endometrial hyperplasia, endometrial cancer
Biopsy of the endometrium, using either D&C or pipelle test → endometrial cancer
Hysteroscopy, to take photos of the cervix, uterus and endometrium
Pt's who are on HRT and have a uterus (i.e. no hysterectomy), require progesterone for endometrial protection
In 90% of cases, a particular cause of postmenopausal bleeding will not be found