Postmenopausal Bleeding

Excerpt

Menopause is characterized by the complete absence of menstrual cycles, which occurs when a female has no ovarian follicles left in reserve and is clinically diagnosed when a woman has had amenorrhea for 1 year. In the United States, the average age of menopause is 51. Bleeding after menopause has been established, termed postmenopausal bleeding, is considered abnormal and is the reason for approximately two-thirds of all gynecologic office visits in postmenopausal women.

The differential diagnoses associated with postmenopausal bleeding (PMB) include several conditions. Though the most common cause of PMB is atrophy of the lower reproductive tract, 90% of postmenopausal women diagnosed with endometrial cancer presented with vaginal bleeding. As with most malignancies, early diagnosis and management lead to a significantly more favorable prognosis. Therefore, any postmenopausal woman with vaginal bleeding should be promptly and appropriately evaluated through a comprehensive clinical examination and diagnostic studies, including endometrial biopsy and imaging. Typically, management depends on the etiology identified. Due to the frequency with which clinicians encounter postmenopausal bleeding, healthcare professionals should have enhanced knowledge in selecting appropriate diagnostic tests, managing the etiology, and fostering effective interprofessional teamwork to improve outcomes in patients with this common condition.