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
Copyright © Nucleus Medical Media, Inc.
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