Materiały źródłowe

• #1 Postmenopausal Bleeding: Causes, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/21549-postmenopausal-bleeding

  Postmenopausal bleeding is vaginal bleeding that occurs a year or more after your last menstrual period. It can be a symptom of vaginal dryness, polyps (noncancerous growths) or other changes in your reproductive system. In about 10% of women, bleeding after menopause is a sign of uterine cancer. […] In most cases, postmenopausal bleeding is due to benign (noncancerous) conditions and isnt a cause for worry. But for about 10% of women, bleeding after menopause is an early sign of uterine cancer (cancer in the lining of your uterus). Talk to your healthcare provider if you experience any bleeding after menopause. Theyll want to run tests to rule out serious medical conditions. […] Contact your healthcare provider if you experience bleeding after menopause as it could be a sign of a medical condition.

• #2 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562188/

  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. […] 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. […] 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. […] 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.

• #3 Postmenopausal Bleeding | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27521

  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. […] 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. […] 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. […] 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.

• #4 Post-Menopausal Bleeding | OB/GYN – Kelsey-Seybold Clinic

  https://www.kelsey-seybold.com/medical-services-and-specialties/obgyn/womens-health/menopause/post-menopausal-bleeding

  Post-Menopausal Bleeding […] Bleeding After Menopause […] In menopause, no further uterine bleeding is expected. When bleeding does occur, it needs to be carefully evaluated. This could be a sign of health problems. The bleeding may be very light to heavy. Bleeding that occurs after menopause can be caused by hormone imbalances or abnormal tissue. The abnormal tissue is the greatest concern. This could mean polyps, excessive growth of the inner lining of the uterus, or precancerous and even cancerous tissue. […] What Should You Do? […] When bleeding occurs in menopause it is very important to contact your doctor for an examination. This visit would include a review of your history, medications, and a pelvic examination. A pelvic ultrasound can help evaluate the uterus further, which helps your doctor decide on the next steps.

• #5 5 Things to Know About Postmenopausal Bleeding | Fox Chase Cancer Center – Philadelphia PA

  https://www.foxchase.org/blog/5-things-know-about-postmenopausal-bleeding

  Spotting or light bleeding after menopause might not seem like a serious problem, but you should never ignore it or wait to bring it up with your doctor. […] Postmenopausal bleeding is never normal. […] Whether its light spotting or a heavier flow, vaginal bleeding after menopause can signal potential health problems. […] It should always be brought up with your provider, said Gina M. Mantia-Smaldone, MD, a gynecologic oncologist at Fox Chase Cancer Center. […] The longer youve been in menopause, the less likely you are to experience postmenopausal bleeding. […] Women are significantly more likely to have bleeding in the first year of menopause compared to later on, research shows. […] But women whove been postmenopausal for a while still need to pay attention to any bleedingendometrial cancer most commonly affects women in their mid-60s.

• #6 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562188/

  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. […] 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. […] 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. […] 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.

• #7 Approach to the patient with postmenopausal uterine bleeding – UpToDate

  https://www.uptodate.com/contents/approach-to-the-patient-with-postmenopausal-uterine-bleeding

  The evaluation and management of postmenopausal patients with a nonuterine source of vaginal bleeding, as well as premenopausal patients with AUB, are discussed separately. […] PMB accounts for approximately 5 percent of office gynecology visits and occurs in approximately 4 to 11 percent of postmenopausal patients. […] The incidence appears to be inversely related to the time since menopause, with the likelihood of bleeding decreasing over time. In a prospective study including 271 Danish postmenopausal patients who completed a daily diary for one year, more patients experienced PMB after the first 12 months of amenorrhea following menopause compared with >3 years after menopause (estimated incidence of bleeding 409 per 1000 versus 42 per 1000 person-years).

• #8 Approach to the patient with postmenopausal uterine bleeding – UpToDate

  https://www.uptodate.com/contents/approach-to-the-patient-with-postmenopausal-uterine-bleeding

  The evaluation and management of postmenopausal patients with a nonuterine source of vaginal bleeding, as well as premenopausal patients with AUB, are discussed separately. […] PMB accounts for approximately 5 percent of office gynecology visits and occurs in approximately 4 to 11 percent of postmenopausal patients. […] The incidence appears to be inversely related to the time since menopause, with the likelihood of bleeding decreasing over time. In a prospective study including 271 Danish postmenopausal patients who completed a daily diary for one year, more patients experienced PMB after the first 12 months of amenorrhea following menopause compared with >3 years after menopause (estimated incidence of bleeding 409 per 1000 versus 42 per 1000 person-years).

• #9 Postmenopausal Bleeding: Causes, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/21549-postmenopausal-bleeding

  Postmenopausal bleeding is vaginal bleeding that occurs a year or more after your last menstrual period. It can be a symptom of vaginal dryness, polyps (noncancerous growths) or other changes in your reproductive system. In about 10% of women, bleeding after menopause is a sign of uterine cancer. […] In most cases, postmenopausal bleeding is due to benign (noncancerous) conditions and isnt a cause for worry. But for about 10% of women, bleeding after menopause is an early sign of uterine cancer (cancer in the lining of your uterus). Talk to your healthcare provider if you experience any bleeding after menopause. Theyll want to run tests to rule out serious medical conditions. […] Contact your healthcare provider if you experience bleeding after menopause as it could be a sign of a medical condition.

• #10 Bleeding After Menopause Could Be a Problem. Here’s What to Know. | ACOG

  https://www.acog.org/womens-health/experts-and-stories/the-latest/bleeding-after-menopause-could-be-a-problem-heres-what-to-know

  Bleeding after menopause is not normal, so take it seriously. Go directly to your ob-gyn. […] Polyps also can cause vaginal bleeding. If your ob-gyn discovers these benign (noncancerous) growths in your uterus or on your cervix, you might need surgery to remove them. […] Another possibility: You could be bleeding because the lining of your uterus is becoming too thick. In some cases, the cells of the lining can become abnormal, leading to cancer. […] Cancer is the most serious, but also least likely, cause of bleeding after menopause. If testing finds cancerous cells or cell changes that could lead to cancer, your ob-gyn should refer you to a specialist called a gynecologic oncologist. […] Even if it isnt cancer, you may need future ultrasounds to keep an eye on things. If you find the bleeding or follow-up tests to be very bothersome, and other treatments havent worked, talk with your ob-gyn. In some cases, you could consider a hysterectomy to remove your uterus. You and your ob-gyn can discuss what might be right for you.

• #11

  https://www.nursingcenter.com/journalarticle?Article_ID=597100&Journal_ID=54012&Issue_ID=597063

  Although postmenopausal bleeding (PMB) accounts for only 5% of all gynecologic office visits, its evaluation is a source of consternation for many providers. The top three diagnoses associated with PMB are endometrial atrophy (40% to 50%), endometrial cancer (10%), and polyps (3%). Because 90% of PMB is associated with a benign condition, the ideal diagnostic method is noninvasive. This reduces individual risk and increases accurate diagnosis of malignancy. […] Ultrasonography is nonsurgical and a relatively noninvasive diagnostic method for evaluation of PMB, and its use is now widespread. […] Transvaginal ultrasound (TVUS) is the least invasive diagnostic tool for the evaluation of PMB, and is fairly accurate in ruling out malignancy. It is typically used in the initial evaluation of PMB and after an unsuccessful EMB to confirm the result and to guide further diagnostic tests.

• #12 Postmenopausal Bleeding | Intimate Wellness Institute

  https://iwiva.com/home-page/womens-speciality-care/advanced-gynecology/postmenopausal-bleeding/

  Postmenopausal bleeding is bleeding that occurs after menopause. Vaginal bleeding that occurs more than a year after a womans last period isnt normal. […] Postmenopausal bleeding is usually due to benign (noncancerous) gynecological conditions such as endometrial polyps. But for about 10% of women, bleeding after menopause is a sign of uterine cancer (endometrial cancer). […] Do not ignore postmenopausal bleeding. Make an appointment with Dr. Guerette or an IWI team member. […] Treatment for postmenopausal bleeding depends on its cause. Medication and surgery are the most common treatments. […] Antibiotics can treat most infections of the cervix or uterus. […] Estrogen may help bleeding due to vaginal dryness. […] Progestin is a synthetic form of the hormone progesterone. It can treat endometrial hyperplasia by triggering the uterus to shed its lining. […] Hysteroscopy is a procedure to examine your cervix and uterus with a camera. […] Dilation and curettage (DC) is a procedure to sample the lining and contents of the uterus. […] Hysterectomy is a surgery to remove your uterus and cervix.

• #13 Postmenopausal Bleeding | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27521

  The most common cause of postmenopausal bleeding is genitourinary atrophy, accounting for 60%. […] Vaginal dryness may be treated with nonhormonal vaginal moisturizers and lubricants to maintain sexual activity. […] Vulvar and vaginal atrophy symptoms can be effectively reversed by topical estrogen and are the preferred pharmacologic therapy for genitourinary atrophy. […] Surgical excision should be considered in asymptomatic women at higher risk of malignancy (eg, large polyps, tamoxifen use, obesity, or diabetes). […] The underlying cause primarily directs the treatment of PMB. […] Clinicians should provide perimenopausal patients with anticipatory education regarding menopausal transition and typical changes that may occur during menstrual cycles. […] Effective interprofessional communication and shared decision-making are pivotal in aligning the teams efforts, improving outcomes, and enhancing patient satisfaction.

• #14 Vaginal Bleeding After Menopause: Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.vaginal-bleeding-after-menopause-care-instructions.uh2921

  Vaginal bleeding after menopause can have many causes. Causes may include cancer, infection, inflammation, prescription hormones, abnormal growths, or injury. Your doctor may want you to have more tests to find the cause of your vaginal bleeding. […] Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take. […] Call your doctor now or seek immediate medical care if: You have severe vaginal bleeding. This means that you are soaking through your usual pads or tampons every hour for 2 or more hours. […] Watch closely for changes in your health, and be sure to contact your doctor if: Your bleeding gets worse. You do not get better as expected.

• #15

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=uh2921

  Vaginal bleeding after menopause can have many causes. Causes may include cancer, infection, inflammation, prescription hormones, abnormal growths, or injury. Your doctor may want you to have more tests to find the cause of your vaginal bleeding. […] Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line (811 in most provinces and territories) if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take. […] Call your doctor or nurse advice line now or seek immediate medical care if: You have severe vaginal bleeding. This means that you are soaking through your usual pads or tampons every hour for 2 or more hours. […] Watch closely for changes in your health, and be sure to contact your doctor or nurse advice line if: Your bleeding gets worse. You do not get better as expected.

• #16 Bleeding After Menopause Could Be a Problem. Here’s What to Know. | ACOG

  https://www.acog.org/womens-health/experts-and-stories/the-latest/bleeding-after-menopause-could-be-a-problem-heres-what-to-know

  My patient Rosa has come to my office for an appointment, but its not for her annual visit. Instead, shes here for vaginal bleeding that has taken her by surprise. Rosa is a woman in her mid-60s whos well past menopause. […] Most women who experience bleeding after menopause are understandably concerned. After all, they thought they were done with it. (Menopause is officially confirmed if it has been 1 year since your last menstrual period.) […] Postmenopausal bleeding can range from light spotting that is pinkish-gray or brown, all the way to a heavy flow, like a regular period. Most of the time, there is no pain with the bleeding. No matter your exact symptoms, youll want to get in touch with your ob-gyn right away if this happens to you. […] A pelvic exam usually is needed when were talking about unexplained vaginal bleeding. During the exam, your ob-gyn may look at your vagina and cervix and feel the size of your uterus.

• #17 Postmenopausal Bleeding: Causes in Women Over 50

  https://www.verywellhealth.com/postmenopausal-bleeding-8406586

  Bleeding sometimes, but not always, suggests endometrial cancer. […] Postmenopausal bleeding is bleeding from the vagina that occurs after menopause. […] Vaginal bleeding after menopause can manifest in different ways. Any type warrants a medical evaluation. […] Postmenopausal bleeding may involve: A streak or drop of blood on underwear or toilet paper, Light bleeding (spotting), Bleeding that is similar to menstrual periods before menopause, Heavy bleeding with or without blood clots, Bleeding that occurs after sex, Pink, gray, or brown vaginal discharge. […] Other symptoms may also be present depending on the cause of the postmenopausal bleeding. These include: Lower abdominal/pelvic pain or pressure, Fever, Dizziness, Fatigue, Pale skin, Low back pain, Constipation, Urinary problems (e.g., frequent urination or feeling the urge to urinate despite an empty bladder).

• #18 Bleeding After Menopause Could Be a Problem. Here’s What to Know. | ACOG

  https://www.acog.org/womens-health/experts-and-stories/the-latest/bleeding-after-menopause-could-be-a-problem-heres-what-to-know

  My patient Rosa has come to my office for an appointment, but its not for her annual visit. Instead, shes here for vaginal bleeding that has taken her by surprise. Rosa is a woman in her mid-60s whos well past menopause. […] Most women who experience bleeding after menopause are understandably concerned. After all, they thought they were done with it. (Menopause is officially confirmed if it has been 1 year since your last menstrual period.) […] Postmenopausal bleeding can range from light spotting that is pinkish-gray or brown, all the way to a heavy flow, like a regular period. Most of the time, there is no pain with the bleeding. No matter your exact symptoms, youll want to get in touch with your ob-gyn right away if this happens to you. […] A pelvic exam usually is needed when were talking about unexplained vaginal bleeding. During the exam, your ob-gyn may look at your vagina and cervix and feel the size of your uterus.

• #19 Postmenopausal Bleeding: Causes in Women Over 50

  https://www.verywellhealth.com/postmenopausal-bleeding-8406586

  Bleeding sometimes, but not always, suggests endometrial cancer. […] Postmenopausal bleeding is bleeding from the vagina that occurs after menopause. […] Vaginal bleeding after menopause can manifest in different ways. Any type warrants a medical evaluation. […] Postmenopausal bleeding may involve: A streak or drop of blood on underwear or toilet paper, Light bleeding (spotting), Bleeding that is similar to menstrual periods before menopause, Heavy bleeding with or without blood clots, Bleeding that occurs after sex, Pink, gray, or brown vaginal discharge. […] Other symptoms may also be present depending on the cause of the postmenopausal bleeding. These include: Lower abdominal/pelvic pain or pressure, Fever, Dizziness, Fatigue, Pale skin, Low back pain, Constipation, Urinary problems (e.g., frequent urination or feeling the urge to urinate despite an empty bladder).

• #20

  https://6abc.com/postmenopausal-bleeding-fox-chase-cancer-center-menopause/12177964/

  About 10 percent of the time, endometrial cancer is the cause. […] Surgery is very successful, if the cancer is caught early. […] Stage 1 cancers have a 95 percent five-year survival rate. […] But Dr. Chu says she and her colleagues are seeing a deadly trend. […] „An alarming rise in the seriousness of endometrial cancer, and actually a rise in the death rate and mortality from endometrial cancer over the last 5-10 years,” she notes. […] Endometrial cancer is the only major cancer increasing in frequency and mortality. […] „The biggest risk factor in the U.S. is obesity,” says Dr. Mantia-Smaldone. […] It’s twice as common in overweight women, and three times as common in obese women. […] While researchers look for solutions, women shouldn’t be afraid to speak up. […] „If they feel they’re not being taken seriously, they should feel empowered to get an answer that’s satisfying to them,” says Dr. Cu.

• #21 Management of unscheduled bleeding on hormone replacement therapy (HRT) – British Menopause Society

  https://thebms.org.uk/publications/bms-guidelines/management-of-unscheduled-bleeding-on-hormone-replacement-therapy-hrt/

  When women present with unscheduled bleeding on HRT, clinical assessment should start with a comprehensive review detailing bleeding patterns, HRT preparations and individual risk factors for cancer. Offer an examination (abdominal, pelvic) and, where relevant, initial investigations such as cervical screening, lower genital tract swabs and body-mass index (BMI). […] Risk factors for endometrial hyperplasia and cancer, independent of HRT, should be identified. Major risk factors are BMI ≥ 40 and hereditary conditions such as Lynch or Cowden syndrome. Minor risk factors include BMI 30-39, diabetes and polycystic ovarian syndrome (PCOS). Optimisation of modifiable factors can, in themselves, reduce episodes of unscheduled bleeding on HRT and endometrial cancer risk. […] In the absence of risk factors for endometrial cancer, offer adjustments in the progestogen or HRT preparation, for 6 months in total, if unscheduled bleeding a) occurs within six months of starting HRT or b) is persisting three months after a change in HRT dose or preparation.

• #22 Postmenopausal Bleeding (PMB) | Doctor

  https://patient.info/doctor/postmenopausal-bleeding

  Postmenopausal bleeding (PMB) is defined for practical purposes as vaginal bleeding occurring after twelve months of amenorrhoea, in a woman of the age where the menopause can be expected. […] Although PMB usually has a benign cause, the priority is to exclude malignancy. […] History and examination may possibly indicate cause, but it is generally accepted that PMB should be treated as malignant, until proved otherwise. […] This requires referral to a gynaecologist with an appointment within two weeks. […] Most women with PMB will not have significant pathology but the dictum remains that postmenopausal bleeding is cancer until proved otherwise. […] Women with breast cancer who take tamoxifen on a long-term basis are at increased risk of endometrial cancer. In view of the increased risk of endometrial cancer associated with tamoxifen therapy, there is a case for heightened vigilance for PMB by both the women and the clinician(s) responsible for their care.

• #23 Postmenopausal bleeding

  https://www.nhs.uk/conditions/post-menopausal-bleeding/

  Menopause is usually diagnosed in women over 45 who have not had a period for more than a year. Any bleeding from the vagina after this time needs to be checked by a GP. […] You have postmenopausal bleeding, even if: […] Postmenopausal bleeding is not usually serious, but can be a sign of cancer. Cancer may be easier to treat if it’s found early. […] If you have postmenopausal bleeding, a GP should refer you to hospital or a special postmenopausal bleeding clinic. […] A specialist, who may be a nurse, will offer you tests to help find out what’s causing the bleeding and plan any necessary treatment. […] Treatment for postmenopausal bleeding depends on what’s causing it.

• #24 Post Menopausal Bleeding – RCEMLearning

  https://www.rcemlearning.co.uk/reference/post-menopausal-bleeding/

  PMB although not uncommon needs adequate attention to rule out sinister pathologies. […] NICE guidelines advise that women with PMB should be urgently referred for a specialist opinion to exclude malignancy. […] A structured history and examination will help rule out emergent diagnoses in the ED. […] Most patients with PMB can be discharged with appropriate gynaecology referrals. Patients with anaemia or hemodynamic instability will require admission for further treatment. […] In the ED, seek advice from your seniors or gynaecology colleagues as to what the best pathway for the patient would be to reduce the chances of loss of follow-up.

• #25 Post Menopausal Bleeding – RCEMLearning

  https://www.rcemlearning.co.uk/reference/post-menopausal-bleeding/

  PMB although not uncommon needs adequate attention to rule out sinister pathologies. […] NICE guidelines advise that women with PMB should be urgently referred for a specialist opinion to exclude malignancy. […] A structured history and examination will help rule out emergent diagnoses in the ED. […] Most patients with PMB can be discharged with appropriate gynaecology referrals. Patients with anaemia or hemodynamic instability will require admission for further treatment. […] In the ED, seek advice from your seniors or gynaecology colleagues as to what the best pathway for the patient would be to reduce the chances of loss of follow-up.

• #26 Postmenopausal Bleeding: Causes, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/21549-postmenopausal-bleeding

  Vaginal bleeding after menopause is harmless most of the time. But postmenopausal bleeding can be a sign of a more serious medical condition, such as uterine, cervical or ovarian cancer. Because theres a chance the bleeding is due to cancer, its best to contact your provider for an appointment. […] Your healthcare provider may perform all or some of the following tests to determine whats causing your postmenopausal vaginal bleeding: Pelvic exam to check your vagina and cervix. Pap smear to check for irregular cells on your cervix. Transvaginal ultrasound. Endometrial biopsy to collect cells from your uterine lining. […] Treatment for postmenopausal bleeding depends on its cause. Medication and surgery are the most common treatments. […] Contact your healthcare provider if you experience any vaginal bleeding: More than a year after your last menstrual period. More than a year after starting hormone replacement therapy (HRT). […] In most cases, vaginal bleeding after menopause is harmless. But it can be a sign of a more serious condition.

• #27 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562188/

  On physical exam, it is crucial to thoroughly evaluate the internal and external anatomy of the genital tract. […] A speculum exam should be performed to visualize bleeding sites, genital lesions, lacerations, urethral prolapse, and signs of genitourinary atrophy, which typically include pale, dry vaginal epithelium with loss of rugae. […] The underlying cause primarily directs the treatment of PMB. […] However, other clinical factors, including patient comorbidities and preferences, as well as PMB characteristics (eg, heaviness and duration), are considered when determining management. […] Clinicians should provide perimenopausal patients with anticipatory education regarding menopausal transition and typical changes that may occur during menstrual cycles. […] Patients should be educated that any bleeding after menopause is established is considered abnormal. […] Effective interprofessional communication and shared decision-making are pivotal in aligning the teams efforts, improving outcomes, and enhancing patient satisfaction.

• #28 Management of unscheduled bleeding on hormone replacement therapy (HRT) – British Menopause Society

  https://thebms.org.uk/publications/bms-guidelines/management-of-unscheduled-bleeding-on-hormone-replacement-therapy-hrt/

  When women present with unscheduled bleeding on HRT, clinical assessment should start with a comprehensive review detailing bleeding patterns, HRT preparations and individual risk factors for cancer. Offer an examination (abdominal, pelvic) and, where relevant, initial investigations such as cervical screening, lower genital tract swabs and body-mass index (BMI). […] Risk factors for endometrial hyperplasia and cancer, independent of HRT, should be identified. Major risk factors are BMI ≥ 40 and hereditary conditions such as Lynch or Cowden syndrome. Minor risk factors include BMI 30-39, diabetes and polycystic ovarian syndrome (PCOS). Optimisation of modifiable factors can, in themselves, reduce episodes of unscheduled bleeding on HRT and endometrial cancer risk. […] In the absence of risk factors for endometrial cancer, offer adjustments in the progestogen or HRT preparation, for 6 months in total, if unscheduled bleeding a) occurs within six months of starting HRT or b) is persisting three months after a change in HRT dose or preparation.

• #29 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562188/

  On physical exam, it is crucial to thoroughly evaluate the internal and external anatomy of the genital tract. […] A speculum exam should be performed to visualize bleeding sites, genital lesions, lacerations, urethral prolapse, and signs of genitourinary atrophy, which typically include pale, dry vaginal epithelium with loss of rugae. […] The underlying cause primarily directs the treatment of PMB. […] However, other clinical factors, including patient comorbidities and preferences, as well as PMB characteristics (eg, heaviness and duration), are considered when determining management. […] Clinicians should provide perimenopausal patients with anticipatory education regarding menopausal transition and typical changes that may occur during menstrual cycles. […] Patients should be educated that any bleeding after menopause is established is considered abnormal. […] Effective interprofessional communication and shared decision-making are pivotal in aligning the teams efforts, improving outcomes, and enhancing patient satisfaction.

• #30 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562188/

  On physical exam, it is crucial to thoroughly evaluate the internal and external anatomy of the genital tract. […] A speculum exam should be performed to visualize bleeding sites, genital lesions, lacerations, urethral prolapse, and signs of genitourinary atrophy, which typically include pale, dry vaginal epithelium with loss of rugae. […] The underlying cause primarily directs the treatment of PMB. […] However, other clinical factors, including patient comorbidities and preferences, as well as PMB characteristics (eg, heaviness and duration), are considered when determining management. […] Clinicians should provide perimenopausal patients with anticipatory education regarding menopausal transition and typical changes that may occur during menstrual cycles. […] Patients should be educated that any bleeding after menopause is established is considered abnormal. […] Effective interprofessional communication and shared decision-making are pivotal in aligning the teams efforts, improving outcomes, and enhancing patient satisfaction.

• #31 Postmenopausal Bleeding: Causes, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/21549-postmenopausal-bleeding

  Vaginal bleeding after menopause is harmless most of the time. But postmenopausal bleeding can be a sign of a more serious medical condition, such as uterine, cervical or ovarian cancer. Because theres a chance the bleeding is due to cancer, its best to contact your provider for an appointment. […] Your healthcare provider may perform all or some of the following tests to determine whats causing your postmenopausal vaginal bleeding: Pelvic exam to check your vagina and cervix. Pap smear to check for irregular cells on your cervix. Transvaginal ultrasound. Endometrial biopsy to collect cells from your uterine lining. […] Treatment for postmenopausal bleeding depends on its cause. Medication and surgery are the most common treatments. […] Contact your healthcare provider if you experience any vaginal bleeding: More than a year after your last menstrual period. More than a year after starting hormone replacement therapy (HRT). […] In most cases, vaginal bleeding after menopause is harmless. But it can be a sign of a more serious condition.

• #32 Postmenopausal bleeding

  https://www2.hse.ie/conditions/postmenopausal-bleeding/

  If you have any bleeding from the vagina after this time, contact your GP. […] Postmenopausal bleeding is not usually serious but can be a sign of cancer. Cancer is easier to treat if it’s found early. […] Your GP may refer you to a hospital or a specialist. […] The specialist may do tests to help find out the cause of the bleeding and plan any treatment. […] They may insert a speculum (plastic device) into your vagina to hold it open, to see the inside of the vagina and the cervix. […] Your specialist may also press on your tummy and inside your vagina. This is to check for lumps, tenderness or other abnormalities. […] Other tests may include a vaginal ultrasound scan. A specialist will place a small device in your vagina to scan for any problems. […] You may need a hysteroscopy. You’ll have this under local or general anaesthetic.

• #33

  https://www.nursingcenter.com/journalarticle?Article_ID=597100&Journal_ID=54012&Issue_ID=597063

  Although postmenopausal bleeding (PMB) accounts for only 5% of all gynecologic office visits, its evaluation is a source of consternation for many providers. The top three diagnoses associated with PMB are endometrial atrophy (40% to 50%), endometrial cancer (10%), and polyps (3%). Because 90% of PMB is associated with a benign condition, the ideal diagnostic method is noninvasive. This reduces individual risk and increases accurate diagnosis of malignancy. […] Ultrasonography is nonsurgical and a relatively noninvasive diagnostic method for evaluation of PMB, and its use is now widespread. […] Transvaginal ultrasound (TVUS) is the least invasive diagnostic tool for the evaluation of PMB, and is fairly accurate in ruling out malignancy. It is typically used in the initial evaluation of PMB and after an unsuccessful EMB to confirm the result and to guide further diagnostic tests.

• #34 Postmenopausal bleeding

  https://www2.hse.ie/conditions/postmenopausal-bleeding/

  A specialist will pass a thin, telescope-like camera into your vagina, through the cervix and into your womb. They can look for any problems in your womb. They’ll take a biopsy (tissue sample) for testing. […] Treatment depends on what’s causing your bleeding: […] cervical polyps – your doctor may recommend the removal of the polyps […] endometrial atrophy – you may not need treatment, but other options are oestrogen cream or pessaries […] endometrial hyperplasia – you may need no treatment. In some cases, you may need hormone medicine or a total hysterectomy […] womb cancer – often a total hysterectomy (surgery to remove your uterus, cervix and ovaries) […] ovarian cancer – a total hysterectomy (surgery to remove your uterus, cervix and ovaries).

• #35 Management of unscheduled bleeding on hormone replacement therapy (HRT) – British Menopause Society

  https://thebms.org.uk/publications/bms-guidelines/management-of-unscheduled-bleeding-on-hormone-replacement-therapy-hrt/

  Women with unscheduled bleeding, in the presence of a uniform endometrium which is fully visualised, and measures ≤ 4 mm with ccHRT or ≤ 7 mm with sHRT, can be reassured that the risk of endometrial cancer is low. Offer HRT adjustments for 6 months and then offer endometrial assessment, on an urgent pathway, if bleeding increases during the 6 months or, is continuing after this interval. […] Assess adherence and understanding of how to use the prescribed preparation including dose and duration of progestogen – for example, would a combined patch or pill reduce administration errors when compared to a separate estrogen and progestogen component. […] Offer all women a 52 mg LNG-IUD; this preparation reduces episodes of unscheduled bleeding when compared to all other preparations.

• #36

  https://www.nursingcenter.com/journalarticle?Article_ID=597100&Journal_ID=54012&Issue_ID=597063

  The widespread use of hysteroscopy, and the ability to perform it on an outpatient basis, has resulted in a reduction in the use of D C for the evaluation of PMB. […] A negative EMS measurement ( 5 mm) should be followed by additional tests to identify a cause for the ultrasonographic abnormality such as polyps, hormone use, leiomyoma, or endometrial cancer. The EMS should not be used as a screening tool in premenopausal women. It is important to use the correct diagnostic tools to assess each patient, according to their individual needs and histories.

• #37 Postmenopausal Bleeding: Causes, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/21549-postmenopausal-bleeding

  Vaginal bleeding after menopause is harmless most of the time. But postmenopausal bleeding can be a sign of a more serious medical condition, such as uterine, cervical or ovarian cancer. Because theres a chance the bleeding is due to cancer, its best to contact your provider for an appointment. […] Your healthcare provider may perform all or some of the following tests to determine whats causing your postmenopausal vaginal bleeding: Pelvic exam to check your vagina and cervix. Pap smear to check for irregular cells on your cervix. Transvaginal ultrasound. Endometrial biopsy to collect cells from your uterine lining. […] Treatment for postmenopausal bleeding depends on its cause. Medication and surgery are the most common treatments. […] Contact your healthcare provider if you experience any vaginal bleeding: More than a year after your last menstrual period. More than a year after starting hormone replacement therapy (HRT). […] In most cases, vaginal bleeding after menopause is harmless. But it can be a sign of a more serious condition.

• #38 Postmenopausal Bleeding > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/postmenopausal-bleeding

  Abnormal vaginal bleeding that occurs during menopause. […] Treatment of postmenopausal bleeding is based on its cause. […] A number of treatments are available that can address the causes of postmenopausal bleeding, from age-related tissue atrophy to cancer. Early treatment leads to the best outcomes, particularly for women who have cancer. […] It’s important to contact your provider if this occurs. […] Even a single instance of questionable postmenopausal bleeding is worth discussing with a provider. […] Women who experience postmenopausal bleeding usually have positive outcomes. Medication and other treatment options should help to stop bleeding among women whose symptoms are due to non-cancerous causes. […] If a woman experiences postmenopausal bleeding because of endometrial cancer, early detection and treatment will help to improve the outcome.

• #39 Postmenopausal Bleeding | Intimate Wellness Institute

  https://iwiva.com/home-page/womens-speciality-care/advanced-gynecology/postmenopausal-bleeding/

  Postmenopausal bleeding is bleeding that occurs after menopause. Vaginal bleeding that occurs more than a year after a womans last period isnt normal. […] Postmenopausal bleeding is usually due to benign (noncancerous) gynecological conditions such as endometrial polyps. But for about 10% of women, bleeding after menopause is a sign of uterine cancer (endometrial cancer). […] Do not ignore postmenopausal bleeding. Make an appointment with Dr. Guerette or an IWI team member. […] Treatment for postmenopausal bleeding depends on its cause. Medication and surgery are the most common treatments. […] Antibiotics can treat most infections of the cervix or uterus. […] Estrogen may help bleeding due to vaginal dryness. […] Progestin is a synthetic form of the hormone progesterone. It can treat endometrial hyperplasia by triggering the uterus to shed its lining. […] Hysteroscopy is a procedure to examine your cervix and uterus with a camera. […] Dilation and curettage (DC) is a procedure to sample the lining and contents of the uterus. […] Hysterectomy is a surgery to remove your uterus and cervix.

• #40 Postmenopausal Bleeding | Intimate Wellness Institute

  https://iwiva.com/home-page/womens-speciality-care/advanced-gynecology/postmenopausal-bleeding/

  Postmenopausal bleeding is bleeding that occurs after menopause. Vaginal bleeding that occurs more than a year after a womans last period isnt normal. […] Postmenopausal bleeding is usually due to benign (noncancerous) gynecological conditions such as endometrial polyps. But for about 10% of women, bleeding after menopause is a sign of uterine cancer (endometrial cancer). […] Do not ignore postmenopausal bleeding. Make an appointment with Dr. Guerette or an IWI team member. […] Treatment for postmenopausal bleeding depends on its cause. Medication and surgery are the most common treatments. […] Antibiotics can treat most infections of the cervix or uterus. […] Estrogen may help bleeding due to vaginal dryness. […] Progestin is a synthetic form of the hormone progesterone. It can treat endometrial hyperplasia by triggering the uterus to shed its lining. […] Hysteroscopy is a procedure to examine your cervix and uterus with a camera. […] Dilation and curettage (DC) is a procedure to sample the lining and contents of the uterus. […] Hysterectomy is a surgery to remove your uterus and cervix.

• #41 Postmenopausal Bleeding: Causes, Diagnosis & Treatment

  https://myallamericanhospice.com/what-is-postmenopausal-bleeding/

  Postmenopausal bleeding is vaginal bleeding after menopause. This bleeding usually occurs after 1 or more 1 years of menopause. […] The bleeding after menopause can be a symptom of virginal dryness or disease. […] If you or your loved one is suffering from postmenopausal bleeding, this article will help you. […] These are reasons which cause light or heavy bleeding after menopause that’s bright red, which can turn out to be dangerous if not taken proper care of. […] Postmenopausal bleeding is vaginal bleeding in the elderly woman whose monthly menstruation cycle has ended. […] Getting consulted by a specialist is preferred. […] The treatment option for your bleeding after menopause will depend upon your symptoms and condition. […] Treatment through medication can include hormonal tablets, antibiotics, infection pills, vaginal creams, and rings.

• #42 Postmenopausal Bleeding | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27521

  The most common cause of postmenopausal bleeding is genitourinary atrophy, accounting for 60%. […] Vaginal dryness may be treated with nonhormonal vaginal moisturizers and lubricants to maintain sexual activity. […] Vulvar and vaginal atrophy symptoms can be effectively reversed by topical estrogen and are the preferred pharmacologic therapy for genitourinary atrophy. […] Surgical excision should be considered in asymptomatic women at higher risk of malignancy (eg, large polyps, tamoxifen use, obesity, or diabetes). […] The underlying cause primarily directs the treatment of PMB. […] Clinicians should provide perimenopausal patients with anticipatory education regarding menopausal transition and typical changes that may occur during menstrual cycles. […] Effective interprofessional communication and shared decision-making are pivotal in aligning the teams efforts, improving outcomes, and enhancing patient satisfaction.

• #43 Why am I experiencing postmenopausal bleeding after six months?

  https://www.icliniq.com/qa/post-traumatic-bleeding/how-can-a-prolonged-post-menopausal-bleeding-be-stopped

  The absence of periods for several months (suggesting menopause), and ongoing bleeding require further evaluation. Possible causes include hormonal fluctuations, endometrial hyperplasia (thickened uterine lining), fibroids or polyps, blood clotting issues (especially with a low platelet count), or, in rare cases, endometrial or cervical abnormalities. While most causes are benign, it is important to rule out serious conditions. […] To manage bleeding, continue Tranexamic Acid (CGTRAN 500 mg) for up to five days, but seek medical review if bleeding persists. A pelvic ultrasound can assess uterine lining thickness, fibroids, or polyps, while blood tests (complete blood count, clotting profile, hormonal levels) can check for underlying issues. If needed, a gynecologist may prescribe progestin medication to control bleeding. Seek urgent care if you experience heavy bleeding (soaking pads every one to two hours), dizziness, or severe fatigue.

• #44 Postmenopausal Bleeding | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27521

  The most common cause of postmenopausal bleeding is genitourinary atrophy, accounting for 60%. […] Vaginal dryness may be treated with nonhormonal vaginal moisturizers and lubricants to maintain sexual activity. […] Vulvar and vaginal atrophy symptoms can be effectively reversed by topical estrogen and are the preferred pharmacologic therapy for genitourinary atrophy. […] Surgical excision should be considered in asymptomatic women at higher risk of malignancy (eg, large polyps, tamoxifen use, obesity, or diabetes). […] The underlying cause primarily directs the treatment of PMB. […] Clinicians should provide perimenopausal patients with anticipatory education regarding menopausal transition and typical changes that may occur during menstrual cycles. […] Effective interprofessional communication and shared decision-making are pivotal in aligning the teams efforts, improving outcomes, and enhancing patient satisfaction.

• #45 Postmenopausal Bleeding | Intimate Wellness Institute

  https://iwiva.com/home-page/womens-speciality-care/advanced-gynecology/postmenopausal-bleeding/

  Postmenopausal bleeding is bleeding that occurs after menopause. Vaginal bleeding that occurs more than a year after a womans last period isnt normal. […] Postmenopausal bleeding is usually due to benign (noncancerous) gynecological conditions such as endometrial polyps. But for about 10% of women, bleeding after menopause is a sign of uterine cancer (endometrial cancer). […] Do not ignore postmenopausal bleeding. Make an appointment with Dr. Guerette or an IWI team member. […] Treatment for postmenopausal bleeding depends on its cause. Medication and surgery are the most common treatments. […] Antibiotics can treat most infections of the cervix or uterus. […] Estrogen may help bleeding due to vaginal dryness. […] Progestin is a synthetic form of the hormone progesterone. It can treat endometrial hyperplasia by triggering the uterus to shed its lining. […] Hysteroscopy is a procedure to examine your cervix and uterus with a camera. […] Dilation and curettage (DC) is a procedure to sample the lining and contents of the uterus. […] Hysterectomy is a surgery to remove your uterus and cervix.

• #46 Postmenopausal bleeding

  https://www2.hse.ie/conditions/postmenopausal-bleeding/

  A specialist will pass a thin, telescope-like camera into your vagina, through the cervix and into your womb. They can look for any problems in your womb. They’ll take a biopsy (tissue sample) for testing. […] Treatment depends on what’s causing your bleeding: […] cervical polyps – your doctor may recommend the removal of the polyps […] endometrial atrophy – you may not need treatment, but other options are oestrogen cream or pessaries […] endometrial hyperplasia – you may need no treatment. In some cases, you may need hormone medicine or a total hysterectomy […] womb cancer – often a total hysterectomy (surgery to remove your uterus, cervix and ovaries) […] ovarian cancer – a total hysterectomy (surgery to remove your uterus, cervix and ovaries).

• #47 Postmenopausal Bleeding | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27521

  The most common cause of postmenopausal bleeding is genitourinary atrophy, accounting for 60%. […] Vaginal dryness may be treated with nonhormonal vaginal moisturizers and lubricants to maintain sexual activity. […] Vulvar and vaginal atrophy symptoms can be effectively reversed by topical estrogen and are the preferred pharmacologic therapy for genitourinary atrophy. […] Surgical excision should be considered in asymptomatic women at higher risk of malignancy (eg, large polyps, tamoxifen use, obesity, or diabetes). […] The underlying cause primarily directs the treatment of PMB. […] Clinicians should provide perimenopausal patients with anticipatory education regarding menopausal transition and typical changes that may occur during menstrual cycles. […] Effective interprofessional communication and shared decision-making are pivotal in aligning the teams efforts, improving outcomes, and enhancing patient satisfaction.

• #48 Postmenopausal bleeding

  https://www2.hse.ie/conditions/postmenopausal-bleeding/

  A specialist will pass a thin, telescope-like camera into your vagina, through the cervix and into your womb. They can look for any problems in your womb. They’ll take a biopsy (tissue sample) for testing. […] Treatment depends on what’s causing your bleeding: […] cervical polyps – your doctor may recommend the removal of the polyps […] endometrial atrophy – you may not need treatment, but other options are oestrogen cream or pessaries […] endometrial hyperplasia – you may need no treatment. In some cases, you may need hormone medicine or a total hysterectomy […] womb cancer – often a total hysterectomy (surgery to remove your uterus, cervix and ovaries) […] ovarian cancer – a total hysterectomy (surgery to remove your uterus, cervix and ovaries).

• #49 Postmenopausal Bleeding – What You Need to Know

  https://www.drugs.com/cg/postmenopausal-bleeding.html

  Postmenopausal bleeding is bleeding that occurs after menopause. A woman who has not had a period for a full year after the age of 40 is considered to be in menopause. Postmenopausal bleeding may range from spotting to very heavy bleeding. […] Treatment depends on the cause of your postmenopausal bleeding. If you have polyps, you may need surgery to remove them. Endometrial atrophy can be treated with medicines. Endometrial hyperplasia may be treated with progestin hormone therapy. Surgery to remove your uterus will be needed if you have endometrial or uterine cancer. Your fallopian tubes, ovaries, and nearby lymph nodes may also be removed. […] You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment.

• #50 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562188/

  On physical exam, it is crucial to thoroughly evaluate the internal and external anatomy of the genital tract. […] A speculum exam should be performed to visualize bleeding sites, genital lesions, lacerations, urethral prolapse, and signs of genitourinary atrophy, which typically include pale, dry vaginal epithelium with loss of rugae. […] The underlying cause primarily directs the treatment of PMB. […] However, other clinical factors, including patient comorbidities and preferences, as well as PMB characteristics (eg, heaviness and duration), are considered when determining management. […] Clinicians should provide perimenopausal patients with anticipatory education regarding menopausal transition and typical changes that may occur during menstrual cycles. […] Patients should be educated that any bleeding after menopause is established is considered abnormal. […] Effective interprofessional communication and shared decision-making are pivotal in aligning the teams efforts, improving outcomes, and enhancing patient satisfaction.

• #51 Postmenopausal Bleeding

  https://irelandsouthwid.cumh.hse.ie/women-s-health/postmenopausal-bleeding/

  Postmenopausal bleeding is vaginal bleeding that happens after your periods have stopped. It is not usually serious, but it can be a sign of cancer. […] This is an outpatient clinic at Cork University Maternity Hospital/SIVUH which looks after women who experience vaginal bleeding after the menopause. […] You will first be seen by a nurse who will check your blood pressure, weight and height and take a urine sample to test it. She will ask you for some information about your problem and your history. You will then see a doctor who may ask some more questions and then do an examination. […] Usually, the cause for bleeding after menopause is due to benign causes like thinning of the tissues in the vagina (atrophy), mild infections (vaginitis) and benign overgrowth of tissue (polyps). However, it is essential to ensure there are no severe problems, such as abnormal cells or cancer of the womb’s lining or other tissues, as these will need to be treated urgently. […] If the investigations are normal, the doctor will let you know this, and you will not need to have any further visits to the hospital about this complaint in the short term.

• #52 Bleeding After Menopause Could Be a Problem. Here’s What to Know. | ACOG

  https://www.acog.org/womens-health/experts-and-stories/the-latest/bleeding-after-menopause-could-be-a-problem-heres-what-to-know

  The next steps will depend on your age, how long it has been since you reached menopause, and how much bleeding youre experiencing. Your ob-gyn might suggest a pelvic ultrasound to look at your uterus more closely or a biopsy to take a tissue sample from the lining of your uterus. You might even need both. […] One reason for postmenopausal bleeding could be that the tissue of your vagina and vulva has gotten thinner. This can happen during menopause due to hormone changes. If you experience the bleeding after sex, it may be from friction against this thinner, more sensitive skinbut your ob-gyn still should do a full evaluation to be sure. […] Topical estrogen cream often resolves this kind of postmenopausal bleeding. Using lubrication during intercourse can help as well. If the lining of your uterus is super-thin, your ob-gyn might consider hormone therapy in the form of pills or an intrauterine device (IUD).

• #53 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562188/

  On physical exam, it is crucial to thoroughly evaluate the internal and external anatomy of the genital tract. […] A speculum exam should be performed to visualize bleeding sites, genital lesions, lacerations, urethral prolapse, and signs of genitourinary atrophy, which typically include pale, dry vaginal epithelium with loss of rugae. […] The underlying cause primarily directs the treatment of PMB. […] However, other clinical factors, including patient comorbidities and preferences, as well as PMB characteristics (eg, heaviness and duration), are considered when determining management. […] Clinicians should provide perimenopausal patients with anticipatory education regarding menopausal transition and typical changes that may occur during menstrual cycles. […] Patients should be educated that any bleeding after menopause is established is considered abnormal. […] Effective interprofessional communication and shared decision-making are pivotal in aligning the teams efforts, improving outcomes, and enhancing patient satisfaction.

• #54

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=uh2921

  Vaginal bleeding after menopause can have many causes. Causes may include cancer, infection, inflammation, prescription hormones, abnormal growths, or injury. Your doctor may want you to have more tests to find the cause of your vaginal bleeding. […] Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line (811 in most provinces and territories) if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take. […] Call your doctor or nurse advice line now or seek immediate medical care if: You have severe vaginal bleeding. This means that you are soaking through your usual pads or tampons every hour for 2 or more hours. […] Watch closely for changes in your health, and be sure to contact your doctor or nurse advice line if: Your bleeding gets worse. You do not get better as expected.

• #55 Vaginal Bleeding After Menopause: Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.vaginal-bleeding-after-menopause-care-instructions.uh2921

  Vaginal bleeding after menopause can have many causes. Causes may include cancer, infection, inflammation, prescription hormones, abnormal growths, or injury. Your doctor may want you to have more tests to find the cause of your vaginal bleeding. […] Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take. […] Call your doctor now or seek immediate medical care if: You have severe vaginal bleeding. This means that you are soaking through your usual pads or tampons every hour for 2 or more hours. […] Watch closely for changes in your health, and be sure to contact your doctor if: Your bleeding gets worse. You do not get better as expected.

• #56 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562188/

  On physical exam, it is crucial to thoroughly evaluate the internal and external anatomy of the genital tract. […] A speculum exam should be performed to visualize bleeding sites, genital lesions, lacerations, urethral prolapse, and signs of genitourinary atrophy, which typically include pale, dry vaginal epithelium with loss of rugae. […] The underlying cause primarily directs the treatment of PMB. […] However, other clinical factors, including patient comorbidities and preferences, as well as PMB characteristics (eg, heaviness and duration), are considered when determining management. […] Clinicians should provide perimenopausal patients with anticipatory education regarding menopausal transition and typical changes that may occur during menstrual cycles. […] Patients should be educated that any bleeding after menopause is established is considered abnormal. […] Effective interprofessional communication and shared decision-making are pivotal in aligning the teams efforts, improving outcomes, and enhancing patient satisfaction.

• #57 Postmenopausal Bleeding | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27521

  The most common cause of postmenopausal bleeding is genitourinary atrophy, accounting for 60%. […] Vaginal dryness may be treated with nonhormonal vaginal moisturizers and lubricants to maintain sexual activity. […] Vulvar and vaginal atrophy symptoms can be effectively reversed by topical estrogen and are the preferred pharmacologic therapy for genitourinary atrophy. […] Surgical excision should be considered in asymptomatic women at higher risk of malignancy (eg, large polyps, tamoxifen use, obesity, or diabetes). […] The underlying cause primarily directs the treatment of PMB. […] Clinicians should provide perimenopausal patients with anticipatory education regarding menopausal transition and typical changes that may occur during menstrual cycles. […] Effective interprofessional communication and shared decision-making are pivotal in aligning the teams efforts, improving outcomes, and enhancing patient satisfaction.

• #58 CE Activity | Postmenopausal Bleeding | Nurses

  https://www.statpearls.com/nurse/ce/activity/103594/?specialty=specialty

  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. […] 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. […] Early diagnosis and management lead to a significantly more favorable prognosis, as with most malignancies. 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. […] This activity for healthcare professionals aims to enhance learners’ competence in selecting appropriate diagnostic tests, managing the identified etiology, and fostering effective interprofessional teamwork to improve outcomes in patients with postmenopausal bleeding. […] At the conclusion of this activity, the learner will be better able to: […] Implement the recommended management of postmenopausal bleeding. […] Apply interprofessional team strategies to improve care coordination and outcomes for patients with postmenopausal bleeding.

• #59 Postmenopausal Bleeding | CommonSpirit Health

  https://www.commonspirit.org/conditions-treatments/postmenopausal-bleeding

  If your doctor gave you medicine, take it exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. […] You may be low in iron if you have heavy bleeding. Eat a balanced diet that is high in iron and vitamin C. Foods rich in iron include red meat, shellfish, eggs, beans, and leafy green vegetables. Talk to your doctor about if you need to take iron pills or a multivitamin.

• #60 Postmenopausal vaginal bleeding – Women’s Healthcare Center

  https://www.womenshealthcarecenter.nl/en/bloedverlies-na-overgang/

  Postmenopausal vaginal bleeding is the occurrence of vaginal bleeding in a woman who has not had a period for at least 12 months. It can be a confusing and concerning experience for some women, but it is relatively common. About 30% of women experience postmenopausal bleeding. […] If you have postmenopausal vaginal bleeding, it is important to make an appointment with your doctor or gynecologist. The doctor will examine you to determine the cause of the bleeding. This is done with a Pap smear of the cervix or with an internal ultrasound. Depending on the cause, there are a variety of treatments available. […] When should you contact Womens Healthcare Center to have the bleeding investigated: You have vaginal bleeding after menopause, The bleeding persists, The bleeding returns, You have abnormal, pink, or brown discharge. […] There are a number of things you can do to reduce the risk of postmenopausal vaginal bleeding, including: Maintain a healthy weight, Stop smoking, Eat enough fiber, Do regular pelvic floor exercises.

• #61

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=uh2921

  Vaginal bleeding after menopause can have many causes. Causes may include cancer, infection, inflammation, prescription hormones, abnormal growths, or injury. Your doctor may want you to have more tests to find the cause of your vaginal bleeding. […] Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line (811 in most provinces and territories) if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take. […] Call your doctor or nurse advice line now or seek immediate medical care if: You have severe vaginal bleeding. This means that you are soaking through your usual pads or tampons every hour for 2 or more hours. […] Watch closely for changes in your health, and be sure to contact your doctor or nurse advice line if: Your bleeding gets worse. You do not get better as expected.

• #62 Vaginal Bleeding After Menopause: Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.vaginal-bleeding-after-menopause-care-instructions.uh2921

  Vaginal bleeding after menopause can have many causes. Causes may include cancer, infection, inflammation, prescription hormones, abnormal growths, or injury. Your doctor may want you to have more tests to find the cause of your vaginal bleeding. […] Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take. […] Call your doctor now or seek immediate medical care if: You have severe vaginal bleeding. This means that you are soaking through your usual pads or tampons every hour for 2 or more hours. […] Watch closely for changes in your health, and be sure to contact your doctor if: Your bleeding gets worse. You do not get better as expected.

• #63 Postmenopausal Vaginal Bleeding

  https://www.uspharmacist.com/article/postmenopausal-vaginal-bleeding

  Although relatively common, vaginal bleeding is considered abnormal when reported in a woman who has passed the onset of menopause. In approximately 20% to 30% of cases of postmenopausal vaginal bleeding, the cause may be attributed to endometrial cancer or atypical endometrial hyperplasia. Additional causes include estrogen or progesterone therapy (i.e., hormone replacement therapy [HRT]) and genital atrophy due to low estrogen levels. […] Regardless of the cause, excessive or prolonged bleeding may result in iron deficiency anemia, a condition that may be especially problematic in the elderly. Pharmacists should refer for evaluation any women over the age of 50 who is experiencing vaginal bleeding for more than six months after her last normal menstrual cycle. […] Persistent postmenopausal vaginal bleeding should be investigated aggressively. Treatment of postmenopausal vaginal bleeding is determined by the cause and should be tailored to the individual. When vaginal bleeding continues without explanation through biopsy results, DC with hysteroscopy is usually necessary. Persistent bleeding requires aggressive investigation to rule out malignancy.

• #64 PMB (postmenopausal bleeding) and HRT – Primary Care Notebook

  https://primarycarenotebook.com/pages/gynaecology/pmb-postmenopausal-bleeding-and-hrt

  in the absence of risk factors for endometrial cancer, offer adjustments in the progestogen or HRT preparation, for 6 months in total, if unscheduled bleeding […] for those women who elect to stop HRT, if the bleeding has settled at a 4-week follow-up, and continued cessation of HRT is acceptable, no further investigations are required […] offer an urgent TVS (within 6 weeks) if the first presentation with bleeding occurs more than six months after initiating, or three months after changing, the HRT preparation […] women with unscheduled bleeding, in the presence of a uniform endometrium which is fully visualised, and measures 4 mm with ccHRT or 7 mm with sHRT, can be reassured that the risk of endometrial cancer is low […] women with a thickened endometrium on TVS (4 mm for ccHRT or 7 mm for sHRT) should be offered referral to the urgent suspicion of cancer pathway (USCP) for endometrial assessment (biopsy and / or hysteroscopy)

• #65 Bleeding After Menopause: Cause for Concern? | MedStar Health

  https://www.medstarhealth.org/blog/vaginal-bleeding-after-menopause

  If you have entered menopause, it is important to tell your doctor about any vaginal bleeding. Together, you can choose the best way to identify and treat the cause. […] Once menopause begins, vaginal bleedingwhether occasional spotting or more significant in volumeis considered abnormal. […] To identify the cause of the bleeding, your doctor will likely perform a speculum exam and a pelvic ultrasound. […] Bleeding caused by endometrial atrophy is often treated with estrogen. For women already on hormone replacement therapy (HRT), a simple adjustment in dose may prevent further issues. […] If you are diagnosed with atypical endometrial hyperplasia, your doctor will refer you to a gynecologic oncologist for treatment. […] Women with endometrial cancer often undergo surgery as part of their treatment. For postmenopausal women, this may include a radical hysterectomy and a bilateral salpingo-oophorectomy. […] Still, vaginal bleeding in post-menopausal women should always be taken seriously as a potential symptom. […] If you have been diagnosed with endometrial hyperplasia or cancer, the team at MedStar Washington Hospital Center is here for you.

• #66 Postmenopausal Bleeding > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/postmenopausal-bleeding

  Abnormal vaginal bleeding that occurs during menopause. […] Treatment of postmenopausal bleeding is based on its cause. […] A number of treatments are available that can address the causes of postmenopausal bleeding, from age-related tissue atrophy to cancer. Early treatment leads to the best outcomes, particularly for women who have cancer. […] It’s important to contact your provider if this occurs. […] Even a single instance of questionable postmenopausal bleeding is worth discussing with a provider. […] Women who experience postmenopausal bleeding usually have positive outcomes. Medication and other treatment options should help to stop bleeding among women whose symptoms are due to non-cancerous causes. […] If a woman experiences postmenopausal bleeding because of endometrial cancer, early detection and treatment will help to improve the outcome.

• #67 An Unwelcome Return

  https://www.sjchs.org/smart-living-home/early-fall-2022/unwelcome-return

  Postmenopausal bleeding can be upsetting, but most cases are benign and treatable. […] It can be disturbing, especially when you thought you wouldn’t bleed anymore, Dr. Lucas says. The good news is that most of the causes of postmenopausal bleeding are not bad things. […] Women with this symptom do need to see a doctor, however. Though not as common, postmenopausal bleeding can be a sign of endometrial cancer. […] If the patient has met the definition of menopause, then it becomes Dr. Lucas investigation to see if endometrial cancer is the cause. If necessary, he will perform an endometrial biopsy to detect cancer cells in the lining of the uterus. […] A common cause of postmenopausal bleeding is endometrial atrophy, in which the lining of the uterus becomes thin and dry. Certain creams or estrogen products can exacerbate the problem and lead to bleeding.

• #68 Postmenopausal Bleeding > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/postmenopausal-bleeding

  Abnormal vaginal bleeding that occurs during menopause. […] Treatment of postmenopausal bleeding is based on its cause. […] A number of treatments are available that can address the causes of postmenopausal bleeding, from age-related tissue atrophy to cancer. Early treatment leads to the best outcomes, particularly for women who have cancer. […] It’s important to contact your provider if this occurs. […] Even a single instance of questionable postmenopausal bleeding is worth discussing with a provider. […] Women who experience postmenopausal bleeding usually have positive outcomes. Medication and other treatment options should help to stop bleeding among women whose symptoms are due to non-cancerous causes. […] If a woman experiences postmenopausal bleeding because of endometrial cancer, early detection and treatment will help to improve the outcome.

• #69

  https://6abc.com/postmenopausal-bleeding-fox-chase-cancer-center-menopause/12177964/

  About 10 percent of the time, endometrial cancer is the cause. […] Surgery is very successful, if the cancer is caught early. […] Stage 1 cancers have a 95 percent five-year survival rate. […] But Dr. Chu says she and her colleagues are seeing a deadly trend. […] „An alarming rise in the seriousness of endometrial cancer, and actually a rise in the death rate and mortality from endometrial cancer over the last 5-10 years,” she notes. […] Endometrial cancer is the only major cancer increasing in frequency and mortality. […] „The biggest risk factor in the U.S. is obesity,” says Dr. Mantia-Smaldone. […] It’s twice as common in overweight women, and three times as common in obese women. […] While researchers look for solutions, women shouldn’t be afraid to speak up. […] „If they feel they’re not being taken seriously, they should feel empowered to get an answer that’s satisfying to them,” says Dr. Cu.

• #70

  https://6abc.com/postmenopausal-bleeding-fox-chase-cancer-center-menopause/12177964/

  About 10 percent of the time, endometrial cancer is the cause. […] Surgery is very successful, if the cancer is caught early. […] Stage 1 cancers have a 95 percent five-year survival rate. […] But Dr. Chu says she and her colleagues are seeing a deadly trend. […] „An alarming rise in the seriousness of endometrial cancer, and actually a rise in the death rate and mortality from endometrial cancer over the last 5-10 years,” she notes. […] Endometrial cancer is the only major cancer increasing in frequency and mortality. […] „The biggest risk factor in the U.S. is obesity,” says Dr. Mantia-Smaldone. […] It’s twice as common in overweight women, and three times as common in obese women. […] While researchers look for solutions, women shouldn’t be afraid to speak up. […] „If they feel they’re not being taken seriously, they should feel empowered to get an answer that’s satisfying to them,” says Dr. Cu.

• #71

  https://6abc.com/postmenopausal-bleeding-fox-chase-cancer-center-menopause/12177964/

  About 10 percent of the time, endometrial cancer is the cause. […] Surgery is very successful, if the cancer is caught early. […] Stage 1 cancers have a 95 percent five-year survival rate. […] But Dr. Chu says she and her colleagues are seeing a deadly trend. […] „An alarming rise in the seriousness of endometrial cancer, and actually a rise in the death rate and mortality from endometrial cancer over the last 5-10 years,” she notes. […] Endometrial cancer is the only major cancer increasing in frequency and mortality. […] „The biggest risk factor in the U.S. is obesity,” says Dr. Mantia-Smaldone. […] It’s twice as common in overweight women, and three times as common in obese women. […] While researchers look for solutions, women shouldn’t be afraid to speak up. […] „If they feel they’re not being taken seriously, they should feel empowered to get an answer that’s satisfying to them,” says Dr. Cu.

• #72 Bleeding After Menopause Could Be a Problem. Here’s What to Know. | ACOG

  https://www.acog.org/womens-health/experts-and-stories/the-latest/bleeding-after-menopause-could-be-a-problem-heres-what-to-know

  Bleeding after menopause is not normal, so take it seriously. Go directly to your ob-gyn. […] Polyps also can cause vaginal bleeding. If your ob-gyn discovers these benign (noncancerous) growths in your uterus or on your cervix, you might need surgery to remove them. […] Another possibility: You could be bleeding because the lining of your uterus is becoming too thick. In some cases, the cells of the lining can become abnormal, leading to cancer. […] Cancer is the most serious, but also least likely, cause of bleeding after menopause. If testing finds cancerous cells or cell changes that could lead to cancer, your ob-gyn should refer you to a specialist called a gynecologic oncologist. […] Even if it isnt cancer, you may need future ultrasounds to keep an eye on things. If you find the bleeding or follow-up tests to be very bothersome, and other treatments havent worked, talk with your ob-gyn. In some cases, you could consider a hysterectomy to remove your uterus. You and your ob-gyn can discuss what might be right for you.

• #73 Bleeding after menopause: It’s not normal | Cancer | UT Southwestern Medical Center

  https://utswmed.org/medblog/postmenopausal-bleeding/

  Too often I see women with advanced endometrial cancer (uterine cancer) who tell me they experienced postmenopausal bleeding for years but didnt think anything of it. This shows we need to do a better job educating our patients about what to expect after menopause. […] Women need to know postmenopausal bleeding is never normal, and it may be an early symptom of endometrial cancer. Any bleeding, even spotting, should trigger a visit to your doctor as soon as possible. […] Early diagnosis offers the best chance to beat endometrial cancer. I urge women to treat postmenopausal bleeding as cancer until proven to be something else. […] Treatment for postmenopausal bleeding depends on its cause. For example, if you have polyps, simply removing them may correct the problem. But if the diagnosis is cancer, you should seek care from a gynecologic oncologist.

• #74 Postmenopausal Bleeding: Causes, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/21549-postmenopausal-bleeding

  Postmenopausal bleeding is vaginal bleeding that occurs a year or more after your last menstrual period. It can be a symptom of vaginal dryness, polyps (noncancerous growths) or other changes in your reproductive system. In about 10% of women, bleeding after menopause is a sign of uterine cancer. […] In most cases, postmenopausal bleeding is due to benign (noncancerous) conditions and isnt a cause for worry. But for about 10% of women, bleeding after menopause is an early sign of uterine cancer (cancer in the lining of your uterus). Talk to your healthcare provider if you experience any bleeding after menopause. Theyll want to run tests to rule out serious medical conditions. […] Contact your healthcare provider if you experience bleeding after menopause as it could be a sign of a medical condition.

• #75 5 Things to Know About Postmenopausal Bleeding | Fox Chase Cancer Center – Philadelphia PA

  https://www.foxchase.org/blog/5-things-know-about-postmenopausal-bleeding

  Spotting or light bleeding after menopause might not seem like a serious problem, but you should never ignore it or wait to bring it up with your doctor. […] Postmenopausal bleeding is never normal. […] Whether its light spotting or a heavier flow, vaginal bleeding after menopause can signal potential health problems. […] It should always be brought up with your provider, said Gina M. Mantia-Smaldone, MD, a gynecologic oncologist at Fox Chase Cancer Center. […] The longer youve been in menopause, the less likely you are to experience postmenopausal bleeding. […] Women are significantly more likely to have bleeding in the first year of menopause compared to later on, research shows. […] But women whove been postmenopausal for a while still need to pay attention to any bleedingendometrial cancer most commonly affects women in their mid-60s.

• #76 Reddit – The heart of the internet

  https://www.reddit.com/r/TwoXChromosomes/comments/md3et7/postmenopausal_bleeding_is_never_good/

  Post-menopausal bleeding is never good. Bleeding after menopause is almost always a sign of something wrong. It might be harmless, but it could be an indicator of cancer. See a doctor.

• #77 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562188/

  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. […] 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. […] 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. […] 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.

• #78 CE Activity | Postmenopausal Bleeding | Nurses

  https://www.statpearls.com/nurse/ce/activity/103594/?specialty=specialty

  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. […] 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. […] Early diagnosis and management lead to a significantly more favorable prognosis, as with most malignancies. 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. […] This activity for healthcare professionals aims to enhance learners’ competence in selecting appropriate diagnostic tests, managing the identified etiology, and fostering effective interprofessional teamwork to improve outcomes in patients with postmenopausal bleeding. […] At the conclusion of this activity, the learner will be better able to: […] Implement the recommended management of postmenopausal bleeding. […] Apply interprofessional team strategies to improve care coordination and outcomes for patients with postmenopausal bleeding.

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