Hospital

Postmenopausal Bleeding

(Bleeding, Postmenopausal; PMB)

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

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Causes

Some causes are:

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

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