Menses

Postmenopausal Bleeding

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Postmenopausal Bleeding, Post-menopausal Bleeding, Uterine Bleeding after Menopause

  • See Also
  1. Abnormal Uterine Bleeding (Dysfunctional Uterine Bleeding)
  2. Endometrial Cancer Screening
  3. Menopause
  4. Menstrual Cycle
  5. Abnormal Uterine Bleeding Causes
  6. Anovulatory Bleeding (Metrorrhagia)
  7. Ovulatory Bleeding (Menorrhagia)
  8. Uterine Bleeding in Pregnancy
  9. First Trimester Bleeding
  10. Late Pregnancy Bleeding
  11. Oral Contraceptive-Related Uterine Bleeding Management
  12. Postmenopausal Bleeding
  13. Amenorrhea
  14. Lower GI Bleed
  15. Hematuria
  • Causes
  1. See Abnormal Uterine Bleeding Causes
  2. Extra-uterine source
    1. Cervical, vaginal, vulvar and Adnexal bleeding
    2. Hematuria (Urethra, Bladder, ureter or Kidney)
    3. Lower Gastrointestinal Bleeding (e.g. Rectal Bleeding)
  3. Evaluate for Malignancy!
    1. Postmenopausal Bleeding is due to malignancy (esp Endometrial Cancer) in up to 40% of cases
    2. Peak Incidence of Endometrial Cancer is age 60-64 years
  4. Atrophic Vaginitis
    1. Most common cause of Postmenopausal Bleeding
  5. Postmenopausal Endometrial Hyperplasia
    1. If no Estrogen Replacement, find Estrogen source
  • Indications
  • Evaluation for Postmenopausal Bleeding
  1. Postmenopause without Hormone Replacement
  2. Postmenopause on Hormone Replacement >6 months
  • Evaluation
  1. See Endometrial Cancer Screening
  2. Careful exam of external genitalia as well as speculum exam
  3. Catheterized Urinalysis
  4. Rectal Exam
  • Imaging
  1. Transvaginal Ultrasound
    1. Determine endometrial thickness (5 mm)
    2. Evaluate for other uterine and Adnexal anomalies
  • Management
  1. See Endometrial Cancer Screening
  • References
  1. Apgar (2003) AAFP Board Review, Seattle