Postmenopausal Bleeding

(Bleeding, Postmenopausal; PMB)

by Cynthia M. Johnson, MA

Definition

Postmenopausal bleeding (PMB) is vaginal bleeding that happens 12 months after a woman’s last menstrual period or in women taking hormone replacement therapy (HRT).

Female Reproductive Organs

Causes

Some causes are:

Continuous HRT
Changes in the endometrial lining of the uterus
Loss of vaginal elasticity
Noncancerous growths on the uterus or cervix
Infection of the uterus or cervix
Uterine or cervical cancer
Fibroid tumors in the uterus or vagina

Risk Factors

Some health problems and medicines can raise the risk of this problem.

Symptoms

Vaginal bleeding is a symptom of PMB.

Diagnosis

You will be asked about your symptoms and health history. A physical exam will be done. It will include a pelvic exam.

The pelvic organs will need to be viewed. This can be done with:

Transvaginal ultrasound
Hysteroscopy
Saline infusion sonohysterography

Cell and tissue samples will be needed for testing. This can be done with:

Endometrial biopsy
Cervical cancer screening

Treatment

Treatment will depend on the cause of the bleeding.

Prevention

There are no current guidelines to prevent PMB.

RESOURCES:

The American Congress of Obstetricians and Gynecologists
https://www.acog.org

Office on Women's Health
https://www.womenshealth.gov

CANADIAN RESOURCES:

Society of Obstetricians and Gynaecologists of Canada
https://sogc.org

Women's Health Matters
https://www.womenshealthmatters.ca

References:

Perimenopausal bleeding and bleeding after menopause. The American College of Obstetricians and Gynecologists website. Available at: https://www.acog.org/patient-resources/faqs/gynecologic-problems/perimenopausal-bleeding-and-bleeding-after-menopause. Updated November 2018. Accessed July 22, 2020.

Postmenopausal bleeding. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/postmenopausal-bleeding. Updated February 18, 2019. Accessed July 22, 2020.

Sonohysterography. Radiology Info—Radiological Society of North America website. Available at: https://www.radiologyinfo.org/en/info.cfm?pg=hysterosono. Updated February 25, 2018. Accessed July 22, 2020.

Turnbull H, Glover A, et al. Investigation and management of abnormal peri-menopausal bleeding. Menopause Int. 2013 Dec;19(4):147-154.

Last reviewed March 2020 by EBSCO Medical Review Board Elliot M. Levine, MD, FACOG
Last Updated: 3/16/2021