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Post Menopausal Bleeding

Postmenopausal bleeding is a condition in which  vaginal bleeding  occurs at least 12 months after woman periods have stopped. Once a woman is at her menopausal age (45-49 years normally) has lasted 12 months without a period, she is believed to be in menopause stage.

It is not normal to bleed after post menopause. Women with postmenopausal bleeding should always see a doctor, in order to rule out serious medical problems even if there is spotting.

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Several health conditions are associated with postmenopausal bleeding, these conditions include:

  • Inflammation and thinning of the vaginal lining or thinning of the womb lining (endometrial atrophy) caused by lower estrogen levels
  • Polyps: Cervical or womb polyps, which are usually non-cancerous, can form in the cervix (neck of the womb) or womb 
  • Hormonal replacement therapy: A thickened womb lining (endometrial hyperplasia) caused by hormone replacement therapy 
  • Abnormalities of the cervix or the womb
  • Endometrial thickening: In this condition, the lining of the uterus (endometrium) becomes thick, usually as a result of too much estrogen and too little progesterone, and bleeding may occur as a result.
  • Endometrial cancer (uterine cancer): Bleeding after menopause can be a sign of endometrial cancer.
  • Other causes includes: Infection of the uterus or cervix, Certain medications such as blood thinners, and other types of cancer can cause postmenopausal bleeding.

Reference: 

For diagnosing the exact cause. Doctor may ask for the medical history  and may conduct a pap smear test. 

Further test that may be advised are:

  • A vaginal ultrasound
  • An endometrial biopsy (sample of the womb lining)
  • Hysteroscopy

Reference: 

Treatment depends on the cause of the post menopausal bleeding:

  • If bleeding is due to polyps, surgery may be required to remove them. 
  • Endometrial atrophy can be treated with medication such as oestrogen cream or pessaries , If post menopausal bleeding is due to   endometrial hyperplasia, it  might be treated with hormone treatment (progestin) or total hysterectomy (surgery to remove cervix, uterus and ovaries)  .
  • If post menausal bleeding is due to hormonal replacement therapy, HRT may be decreased/stopped depending upon the condition.

Reference: 

  • CREATED / VALIDATED BY : NHP CC DC
  • LAST UPDATED ON : Feb 04, 2016

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