Post Menopausal Bleeding

When a woman stops to have periods for one year, the woman is said to have attained menopause. Any bleeding occurring after the period of menopause is called as post menopausal bleeding . This bleeding can be in the form of a little spotting or it can be bleeding like menses .

If you have any such episode of post menopausal bleeding ,you must see a gynecologist as soon as possible . It is of concern as 1 out of every 10 such patients is suffering from some type of uterine cancer . However we must see the positive aspect that in 9 out of every 10 cases ,the cause is usually benign; it is not at all associated with some cancerous condition. One must see a gynecologist and get investigated. One must give a proper history regarding the use of any indigenous medicine , if the women is talking hormone replacement therapy , if there is any history of trauma or there is any history of instrumentation ,it should be given to the doctor .

The doctor will do a local examination to see if there is any local cause of bleeding. An USG would be advised to see for the endometrial thickness and adnexa.

Endometrial thickness(ET) is the lining of the uterine cavity. If ET is more than 4mm,it is considered to be abnormal. Then a hysteroscopic guided biopsy would be advised. Hysteroscopically an abnormal area is identified, biopsy is taken and sent for histopathology. The advantage of hysteroscopy is that if there is any polyp, it can be removed in the same setting.

90% of the times the cause is usually benign. It can be atrophic vaginitis(60-90%), hormonal therapy(15-20%),endometrial hyperplasia, cervical or uterine polyp, endometrial cancer, cervical cancer. After attaining menopause, due to the hormonal deficiency, the walls of vagina are thin, so any abrasion or scratch may lead to bleeding.

So any episode of postmenopausal bleeding should not be neglected.