McKesson Clinical Reference Systems: Women's Health Advisor 2002.2

What is postmenopausal bleeding?

Postmenopausal bleeding is bleeding from the vagina after you have been through menopause. Menopause is the time in your life when menstruation stops permanently (when you stop having menstrual periods for at least 12 months in a row). It usually happens between the ages of 45 and 55. Menopause also happens if you have surgery to remove your uterus and ovaries (a hysterectomy).

If you have bleeding after menopause, it is very important to contact your health care provider as soon as possible to find out the cause.

How does it occur?

Postmenopausal bleeding may be caused by:

• hormone problems
• atrophy of the vagina, which is thinning and drying of the lining of the vagina
• polyps (small growths) in the uterus or on the cervix
• hyperplasia (enlarged cells) of the lining of the uterus
• infection of the cervix
• cancer of the uterus, cervix, or vagina
• some types of ovarian tumors
• anticoagulants (blood-thinner medicines).

How is it diagnosed?

Your health care provider will ask about your medical history and symptoms and give you a physical exam. You may have some tests, such as:

• blood tests to check your hormone levels
• other blood tests
• biopsy (removal of a small amount of tissue) from the vagina, cervix, or uterus for lab tests
• ultrasound scan of your pelvic organs.

Tests you may need that require anesthesia (pain-relieving medicine) are:

• hysteroscopy, a procedure in which your health care provider uses an instrument with a light to look inside the uterus for polyps or other possible problems
• laparoscopy, a procedure in which your provider uses an instrument with a light to look into your pelvis through a small cut in the skin of your abdomen
• D&C, a procedure in which your provider scrapes the inside of the uterus to get tissue, which is sent to the lab for tests.

Some of these tests can be done in your health care provider's office, but some are done in the hospital, especially the tests requiring an anesthetic.

How is it treated?

The treatment depends on the cause of the problem. It may be treated with:

• hormones or, if you are taking hormones, an adjustment in your medicine
• other medicines
• surgery (for example, your uterus, and possibly your ovaries also, may be removed).

How can I help prevent postmenopausal bleeding?

In most cases there is nothing you can do to prevent postmenopausal bleeding. If you are taking hormones or other medicines, they must be taken properly and with the correct dosage to prevent bleeding. Remember that any postmenopausal bleeding needs to be reported to your health care provider. Most of the time the bleeding is not caused by cancer, but it must be checked to make sure.

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.