postmenopausal bleeding

Navigating the Unexpected: A Practical Guide to Postmenopausal Bleeding


Postmenopausal bleeding (PMB) refers to any vaginal bleeding that occurs after 12 months of no periods due to menopause. Although it may be concerning, PMB is not always a sign of a serious issue. However, it’s essential to address it and determine its underlying cause. In this article, we will explore the causes, diagnosis, and treatment options for postmenopausal bleeding.

Causes of postmenopausal bleeding

Several factors can contribute to PMB, including:

  1. Hormone replacement therapy (HRT): Some women may experience vaginal bleeding as a side effect of HRT.
  2. Vaginal atrophy: The thinning and inflammation of the vaginal walls can result in bleeding.
  3. Endometrial polyps: These non-cancerous growths on the uterine lining can lead to PMB.
  4. Endometrial hyperplasia: The thickening of the uterine lining can cause bleeding, particularly if left untreated.
  5. Endometrial cancer: Although rare, PMB can be a symptom of cancer in the lining of the uterus.
  6. Blood-thinning medications: These drugs can increase the risk of bleeding.
  7. Other less common causes: Infections, trauma, or other medical conditions can also lead to PMB.

Assessing postmenopausal bleeding

To determine the cause of PMB, your healthcare professional will perform an initial evaluation, which includes:

  • Detailed history: A thorough review of your medical history and symptoms.
  • Physical examination: A pelvic exam to check for any abnormalities.
  • Transvaginal ultrasonography (TVS): A non-invasive imaging method to visualise the uterus and measure endometrial thickness.

If the initial assessment warrants further investigation, the following methods can be employed:

  1. Endometrial thickness criteria: An endometrial thickness of >4mm often requires additional evaluation.
  2. Endometrial sampling: Outpatient endometrial biopsy (pipelle aspiration) is a minimally invasive method to obtain a tissue sample from the uterine lining.
  3. Hysteroscopy: A procedure that involves inserting a small camera into the uterus to examine its interior.
  4. Dilatation and curettage (D&C): A more invasive method to collect endometrial tissue samples.

Treatment and management options

The treatment approach for PMB depends on the underlying cause:

  • Hormonal therapy: Progestogens or a levonorgestrel intrauterine system (LNG-IUS) can be used to treat endometrial hyperplasia or other hormonal imbalances.
  • Surgical interventions: Polyp removal or hysterectomy may be necessary in cases of endometrial polyps, cancer, or other serious conditions.
  • Treating vaginal atrophy: Local estrogen therapy, vaginal moisturisers, and lubricants can help manage the symptoms of vaginal atrophy.


Postmenopausal bleeding, while not always serious, should not be ignored. Early detection and appropriate management of its underlying causes are crucial to ensure your well-being. Healthcare professionals play a vital role in the diagnosis and treatment of PMB, and open communication between patients and providers is essential. If you experience postmenopausal bleeding, consult your healthcare provider to discuss your concerns and receive proper guidance.

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