Definition of "Postmenopausal bleeding"

Last modified: 3 days

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.

What's menopause?
It's when vaginal bleeding stops for 1 year.

That's different from from how amenorrhea is defined, which is 3 months?


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.

Source: 2099-54-postmenopausal-bleeding.html">RANZCOG

  • Hx:
    • Characterization
    • Associated trauma → pelvic trauma
    • Pain
    • Weight loss → cancer
    • Use of HRT, type, duration
    • Hysterectomy
    • Drugs, including:
      • 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
  • Blood test
  • 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
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Definition of Postmenopausal bleeding | Autoprac

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