Materiały źródłowe

• #1 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

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

  Vaginal bleeding is reported in up to 10% of postmenopausal women and is the presenting symptom for approximately two-thirds of gynecologic office visits in this population. […] However, the incidence of PMB may decrease with age. With the onset of menopause, bleeding is reported in approximately 40% of women per year, but 3 years after menopause, PMB decreases to 4% per year. […] Over 90% of postmenopausal women with endometrial cancer present with PMB. […] The global incidence of endometrial cancer is increasing, primarily due to the increased prevalence of endometrial cancer risk factors (eg, obesity and late menopause). The number of patients diagnosed with endometrial cancer is anticipated to double by the year 2030.

• #2 Postmenopausal Bleeding (PMB) | Doctor

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

  Postmenopausal bleeding (PMB) is a common problem representing 5% of all gynaecology outpatient attendances. These are most commonly to eliminate endometrial cancer as the cause of the bleed. […] PMB is a common problem representing 5% of all gynaecology outpatient attendances. These are most commonly to eliminate endometrial cancer as the cause of the bleed.

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

  http://www.uptodate.com/contents/postmenopausal-uterine-bleeding

  Postmenopausal bleeding (PMB) refers to any uterine bleeding in a menopausal patient (other than the expected cyclic bleeding that occurs in patients taking combined [ie, estrogen-progestin], cyclic, postmenopausal hormone therapy). As PMB is the cardinal sign of endometrial carcinoma, all postmenopausal patients with unanticipated PMB should be evaluated for endometrial hyperplasia/carcinoma. More commonly, however, the cause of bleeding in such patients is the result of a benign condition, such as endometrial polyps or atrophy. […] 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).

• #4

  https://www.ijrcog.org/index.php/ijrcog/article/view/9652

  Postmenopausal bleeding is a worrisome symptom occurring in 10 % of the women, making them seek a gynaecology opinion at the earliest. […] This prospective study was carried out on 75 women presenting with postmenopausal bleeding to the gynaecology clinic at a tertiary hospital set up. […] The study aimed to find the incidence of postmenopausal bleeding, age distribution, causes and different evaluation methods to confirm the diagnosis. […] Postmenopausal bleeding was observed in 50-60 years in 56% of women and 30% above 60 years. […] 53 women had benign causes while 22 had malignancy. […] Benign lesions of the genital tract are common causes of postmenopausal bleeding. Carcinoma cervix and endometrium classically present with postmenopausal bleed. Strong suspicion, thorough evaluation and early diagnosis improve the quality of life and reduce the morbidity and mortality.

• #5 WHO EMRO | Histological findings in women with postmenopausal bleeding: Jordanian figures | Volume 17, issue 7 | EMHJ volume 17, 2011

  https://www.emro.who.int/emhj-volume-17/volume-17-issue-7/article5.html

  Although the rate of postmenopausal bleeding declined with increasing age, the peak incidence of endometrial carcinoma occurred in the age group 7074 years. […] In conclusion, this retrospective study of postmenopausal women with uterine bleeding showed that the number of women with bleeding decreased with increasing age, while the probability of endometrial cancer as the underlying cause increased.

• #6 Closer Look at Postmenopausal Bleeding and Endometrial Cancer – NCI

  https://www.cancer.gov/news-events/cancer-currents-blog/2018/endometrial-cancer-bleeding-common-symptom

  Overall, the analysis showed that, consistent with what had been seen in earlier studies, 90% of women diagnosed with endometrial cancer had experienced postmenopausal bleeding. […] The number of women with postmenopausal bleeding who were diagnosed with endometrial cancer varied around the globe. While the rate was 9% overall, it ranged from 5% in North America to 13% in Western Europe. […] Among the studies included in the analysis, the risk of endometrial cancer in women with postmenopausal bleeding was lower in studies that included women using hormone replacement therapy. […] The findings confirm that „postmenopausal women with [vaginal] bleeding have a low risk of endometrial cancer, but the vast majority of women with endometrial cancer present with bleeding. […] Although they don’t want to alarm anyone with these results, added Dr. Clarke, women should know that getting tested if they have postmenopausal bleeding „gives us an opportunity to [potentially] detect endometrial cancer early, which provides a high likelihood of cure.

• #7 Postmenopausal Bleeding Common in Women With Endometrial Cancer

  https://www.cancernetwork.com/view/postmenopausal-bleeding-common-women-endometrial-cancer

  Risk for cancer in women with postmenopausal bleeding was lowest in North America (5%) and highest in Western Europe (13%). […] The widespread practice of referring all women with postmenopausal bleeding for transvaginal ultrasound and/or endometrial biopsy carries a considerable burden and cost, the researchers wrote. […] In the diagnostic decision process it is relevant to appreciate that approximately 90% of women with endometrial cancer will experience postmenopausal bleeding, but that conversely only about 10% of women with postmenopausal bleeding are ultimately found to have endometrial cancer.

• #7 Postmenopausal Bleeding Common in Women With Endometrial Cancer

  https://www.cancernetwork.com/view/postmenopausal-bleeding-common-women-endometrial-cancer

  A meta-analysis finds that postmenopausal bleeding occurs in approximately 90% of women with endometrial cancer. […] Evaluation of women with postmenopausal bleeding has the potential to capture as many as 90% of endometrial cancers, according to the results of a meta-analysis published recently in JAMA Internal Medicine. […] Current practice guidelines recommend workup to rule out endometrial cancer among all women with postmenopausal bleeding, Clarke and colleagues wrote. Our findings support this recommendation by providing reassurance that targeting this high-risk group of women for early detection and prevention strategies will capture most endometrial cancers. […] Ninety-one percent of women with endometrial cancer had postmenopausal bleeding. […] The overall pooled risk of endometrial cancer among women with postmenopausal bleeding was 9%, according to the study.

• #8 WHO EMRO | Histological findings in women with postmenopausal bleeding: Jordanian figures | Volume 17, issue 7 | EMHJ volume 17, 2011

  https://www.emro.who.int/emhj-volume-17/volume-17-issue-7/article5.html

  Postmenopausal bleeding represents one of the most common reasons for referral to gynaecological services. […] A retrospective review was made of the hospital records of 482 women presenting with postmenopausal bleeding to a referral hospital in Amman, Jordan. […] These preliminary data are the first reports from Jordan of histopathological findings in this group of patients, and a larger study is required to establish national figures. […] A woman not taking hormone replacement therapy (HRT) who bleeds after the menopause has a 10% risk of having genital cancer and a further 10% risk of significant pathology. […] Endometrial atrophy is the most common endometrial finding in women with postmenopausal bleeding, accounting for 60%80% of such bleeding. […] Postmenopausal bleeding is the most common presenting symptom in women diagnosed with endometrial cancer.

• #9 The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Women With Postmenopausal Bleeding | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/05/the-role-of-transvaginal-ultrasonography-in-evaluating-the-endometrium-of-women-with-postmenopausal-bleeding

  Cancer of the endometrium is the most common type of gynecologic cancer in the United States. Vaginal bleeding is the presenting sign in more than 90% of postmenopausal women with endometrial carcinoma. […] The clinical approach to postmenopausal bleeding requires prompt and efficient evaluation to exclude or diagnose endometrial carcinoma and endometrial intraepithelial neoplasia. Transvaginal ultrasonography usually is sufficient for an initial evaluation of postmenopausal bleeding if the ultrasound images reveal a thin endometrial echo (less than or equal to 4 mm), given that an endometrial thickness of 4 mm or less has a greater than 99% negative predictive value for endometrial cancer. […] Transvaginal ultrasonography is a reasonable alternative to endometrial sampling as a first approach in evaluating a postmenopausal woman with an initial episode of bleeding.

• #10 Postmenopausal Bleeding > Fact Sheets > Yale Medicine

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

  Abnormal vaginal bleeding that occurs during menopause. […] After a year has passed without menstrual periods, any vaginal bleeding that that occurs is known as postmenopausal bleeding, and it is considered abnormal. […] However, between 10% and 15% women who experience postmenopausal bleeding may have endometrial cancer. For this reason, its important for women to see a doctor quickly for assessment after even one episode of postmenopausal bleeding. […] Postmenopausal bleeding refers to any vaginal bleeding that occurs in a menopausal woman. Because all postmenopausal bleeding is considered abnormal, its important to contact your provider if this occurs. […] More than 90% of postmenopausal women with endometrial cancer experience vaginal bleeding (postmenopausal bleeding). […] Women who have reached menopause may be at increased risk of postmenopausal bleeding if they: Have a history of uterine or cervical polyps, Have fibroids, Take hormone therapy, Take tamoxifen, Experience vaginal dryness, Experience sexual trauma.

• #11 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. 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). […] Postmenopausal bleeding occurs in about 10% of women over 55. […] 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. […] Not always. While certain cancers can cause bleeding after menopause, cancer isnt the only cause of postmenopausal bleeding. […] Treatment for postmenopausal bleeding depends on its cause. Medication and surgery are the most common treatments. […] In most cases, vaginal bleeding after menopause is harmless. But it can be a sign of a more serious condition.

• #12 Postmenopausal Bleeding | Definition & Patient Education

  https://www.healthline.com/health/postmenopausal-bleeding

  Long-term use of estrogen can lead to increased risk of endometrial hyperplasia. It can ultimately lead to cancer of the uterus if not treated. […] About 10 percent of women who have postmenopausal bleeding have endometrial cancer. […] Postmenopausal bleeding may be benign or could be a result of a more serious condition like cancer. […] When cancers are diagnosed early, the chances of survival are higher. […] To prevent abnormal postmenopausal bleeding, the best strategy is to reduce your risk factors for the conditions that could cause it. […] Postmenopausal bleeding is often successfully treated. If your bleeding is due to cancer, the outlook depends on the type of cancer and stage at which it was diagnosed. The five-year survival rate is about 82 percent.

• #12 Postmenopausal Bleeding | Definition & Patient Education

  https://www.healthline.com/health/postmenopausal-bleeding

  Postmenopausal bleeding occurs in a womans vagina after she has undergone menopause. In order to rule out serious medical problems, women with postmenopausal bleeding should always see a doctor. […] Because abnormal vaginal bleeding can be a symptom of cervical, uterine, or endometrial cancer, you should get any abnormal bleeding evaluated by a doctor. […] Bleeding can occur in postmenopausal women for several reasons. […] There are a variety of other conditions that can cause postmenopausal bleeding. […] Some common causes include: polyps, endometrial hyperplasia, and endometrial atrophy. […] Endometrial hyperplasia is the thickening of the endometrium. It is a potential cause for postmenopausal bleeding. It is often caused when there is an excess of estrogen without enough progesterone. It occurs frequently in women after menopause.

• #13 Bleeding – perimenopausal, postmenopausal and breakthrough bleeding on MHT/HRT – Australasian Menopause Society

  https://www.menopause.org.au/hp/information-sheets/postmenopausal-bleeding-including-breakthrough-on-mht-hrt

  Postmenopausal bleeding (PMB) refers to any vaginal bleeding that occurs in a menopausal woman ie. 12 months after their final menstrual period. This does not include the regular withdrawal bleed that occurs on MHT. […] Any postmenopausal bleeding requires investigation to exclude a sinister cause. The likelihood of endometrial carcinoma for a woman presenting with PMB is 10%. However, around 95% of women with endometrial malignancy will present with PMB. Risk factors for endometrial cancer include age, obesity, use of unopposed oestrogen, polycystic ovary syndrome, Type 2 diabetes mellitus, atypical glandular cells on screening cervical cytology and family history of gynaecologic malignancy. Nulliparity is also a risk factor. Patients taking non-conventional MHT, such as troches and transdermal progestogen are at risk of endometrial hyperplasia and cancer.

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

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

  Vaginal bleeding is reported in up to 10% of postmenopausal women and is the presenting symptom for approximately two-thirds of gynecologic office visits in this population. […] However, the incidence of PMB may decrease with age. With the onset of menopause, bleeding is reported in approximately 40% of women per year, but 3 years after menopause, PMB decreases to 4% per year. […] Endometrial cancer is the fifth most common cause of death due to malignancy in the US and the fourth most common overall cancer in females. […] Furthermore, endometrial cancer is the most commonly diagnosed cancer in women and the most common site of uterine cancer, accounting for 92% of cases. […] Over 90% of postmenopausal women with endometrial cancer present with PMB. […] The global incidence of endometrial cancer is increasing, primarily due to the increased prevalence of endometrial cancer risk factors (eg, obesity and late menopause). The number of patients diagnosed with endometrial cancer is anticipated to double by the year 2030.

• #15 Azthena logo with the word Azthena

  https://www.news-medical.net/news/20240801/Study-Many-women-unaware-postmenopausal-bleeding-signals-endometrial-cancer.aspx

  Despite the fact that endometrial cancer is the most common cancer of the female reproductive organs, a significant percentage of women do not know that postmenopausal bleeding is a key warning sign of the disease. […] Of greater concern is the more than 2% increase in incidence per year in nearly every racial/ethnic group – an increase that is partially because of increasing rates of obesity in the United States. […] Although there is no screening test for endometrial cancer, diagnosis frequently occurs at an early stage because the disease is accompanied by such detectable symptoms, such as abnormal and postmenopausal bleeding. […] A new study based on nearly 650 participants, 145 of whom were postmenopausal, showed that more than one-third of survey participants (37%) did not recognize postmenopausal bleeding as a key symptom, and 41% said they would not tell their healthcare professional if they had postmenopausal bleeding after only one episode.

• #16 Q&A With NCI’s Dr Megan Clarke: Postmenopausal Bleeding as a Red Flag for Cancer | Consultant360

  https://www.consultant360.com/article/consultant360/obstetrics-gynecology/qa-ncis-dr-megan-clarke-postmenopausal-bleeding-red

  Although many women can experience bleeding or spotting as they go through menopause, it is not normal for postmenopausal bleeding to continue 1 year or more after their last menstrual period. […] In fact, postmenopausal bleeding can sometimes signal the presence of harmful underlying conditions including malignancy and warrants medical attention, she said. […] They found that, although most women who experience postmenopausal bleeding will not receive an endometrial cancer diagnosis, a staggering 90% of women who develop this type of cancer experience postmenopausal bleeding as an early symptom of their disease. […] Therefore, recognition of postmenopausal bleeding followed by prompt diagnostic evaluation are critical for early diagnosis and improved survival of endometrial cancer. […] Clinical factors that increase risk of endometrial cancer and should be considered when evaluating women with postmenopausal bleeding include age, obesity, use of unopposed estrogen, medical conditions such as type 2 diabetes and polycystic ovary syndrome, and family history of gynecologic cancer.

• #17 Postmenopausal Bleeding: An Update

  https://ej-med.org/index.php/ejmed/article/view/652

  The clinical approach to postmenopausal bleeding requires prompt and efficient evaluation to exclude or diagnose endometrial carcinoma and endometrial intraepithelial neoplasia and to find out the real source. […] Postmenopausal bleeding is endometrial cancer until proven otherwise, although only 1-14% of such patients will actually have cancer. […] Clinical risk factors of endometrial carcinoma such as obesity, unopposed estrogen use, polycystic ovary syndrome, diabetes mellitus and family history of gynaecologic malignancy also should be considered during evaluation. […] Postmenopausal bleeding usually attributed to an intrauterine source, but it may arise from the cervix, vagina, vulva or fallopian tubes ovaries. […] The origin of bleeding can also involve non-gynaecologic sites, such as the urethra, bladder, anus/rectum/bowel, or perineum.

• #18 Endometrial Biopsy: Tips and Pitfalls | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0501/p551.html

  Endometrial biopsy is a safe and efficient method to evaluate the endometrium for a variety of indications, most commonly abnormal uterine bleeding and postmenopausal bleeding. […] In postmenopausal women, an endometrial biopsy is 90% sensitive for endometrial cancer and 82% sensitive for atypical hyperplasia; the specificity is nearly 100% for both. […] Women with postmenopausal bleeding but no risk factors for endometrial hyperplasia or cancer may have transvaginal ultrasonography or endometrial biopsy as a first-line approach to evaluation. […] In postmenopausal women with bleeding but no other risk factors for endometrial hyperplasia or cancer, endometrial biopsy or transvaginal ultrasonography is a first-line approach. […] Further evaluation including endometrial biopsy is required for endometrial thickness greater than 4 mm on transvaginal ultrasonography or for any women with persistent or recurrent bleeding.

• #19 Bleeding – perimenopausal, postmenopausal and breakthrough bleeding on MHT/HRT – Australasian Menopause Society

  https://www.menopause.org.au/hp/information-sheets/postmenopausal-bleeding-including-breakthrough-on-mht-hrt

  The primary goal of investigation is to exclude malignancy, and secondarily to elucidate a treatable non-malignant cause. […] Endometrial ultrasound is the initial investigation of choice. This should be done by an experienced specialist gynaecological ultrasonographer and with transvaginal ultrasound (TVUS). […] The significance of PMB for the risk of malignancy differs with use of MHT and endometrial thickness on TVUS. […] Tamoxifen therapy is associated with stimulation of the endometrium and an increased risk of endometrial cancer. […] Endometrial biopsy should be performed in women who meet the following criteria: Endometrial thickness 4mm, Not easy display of the endometrium eg. fibroids, Persistent PMB, Suspicion of polyp or mass on transvaginal ultrasound, Endometrial thickness 3mm with fluid in the endometrial cavity. […] Surgical management is appropriate for neoplastic and local lesions causing bleeding. However, women who have heavy or unmanageable breakthrough bleeding in the absence of pathology, may prefer to have a hysterectomy, after which they need take only oestrogen as MHT.

• #20 Postmenopausal Bleeding: An Update

  https://ej-med.org/index.php/ejmed/article/view/652

  Initial evaluation is by TVS, if endometrial thickness (ET) is 4mm no further evaluation is required but follow up consultation must. […] If ET is 4mm, hysteroscopic evaluation and endometrial sampling is recommended. […] Unopposed estrogen therapy is associated with a duration and dose-related increase in risk of endometrial hyperplasia and cancer. […] Endometrial hyperplasia with atypia has much malignant potential but endometrial hyperplasia without atypia may be managed medically with 3 monthly endometrial sampling, if no regression or further progression hysterectomy is the choice of treatment. […] Finally, patient counseling with discussion of risks /benefits of different options of treatment modalities is the cornerstone of success of addressing postmenopausal bleeding.

• #21 Endometrial Biopsy: Tips and Pitfalls | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0501/p551.html

  Endometrial biopsy is recommended for several clinical situations in the absence of abnormal bleeding. […] Women with hereditary nonpolyposis colorectal cancer (formerly known as Lynch syndrome) are advised to have endometrial biopsy performed every one to two years starting at 30 to 35 years of age because of an elevated lifetime risk of endometrial cancer of up to 61%. […] The American Society for Reproductive Medicine, as part of the Choosing Wisely campaign, recommends against endometrial biopsy in the routine evaluation of infertility. […] Insufficient samples are common in postmenopausal women. […] Further evaluation is recommended in all women with postmenopausal bleeding and a normal biopsy because of low sampling accuracy.

• #22 Prevalence of Hysteroscopic Findings in Postmenopausal Bleeding Patients and Its Correlation with Clinicohistopathologic Diagnosis

  https://www.jsafog.com/abstractArticleContentBrowse/JSAFOG/23535/JPJ/fullText

  Hysteroscopy is an easy to perform office procedure that can be done in a short period of time without causing discomfort to patients and their attendants. It is a widely recognized diagnostic modality in the evaluation of abnormal uterine bleeding in premenopausal, perimenopausal, and postmenopausal cases with high accuracy. It is highly accurate for diagnosing endouterine lesions, such as, polyps, submucous myomas, endometrial adenocarcinoma, and hyperplasia, i.e., the conditions associated with PMB. […] Considering the high accuracy of hysteroscopy in evaluation of PMB, the present study was carried out with an aim to evaluate hysteroscopic findings in women with PMB in order to assess the various causes of PMB and to determine their prevalence in our population and its correlation with histopathologic examination.

• #23 The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Women With Postmenopausal Bleeding | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/05/the-role-of-transvaginal-ultrasonography-in-evaluating-the-endometrium-of-women-with-postmenopausal-bleeding

  If blind sampling does not reveal endometrial hyperplasia or malignancy, further testing, such as hysteroscopy with dilation and curettage, is warranted in the evaluation of women with persistent or recurrent bleeding. […] An endometrial measurement greater than 4 mm that is incidentally discovered in a postmenopausal patient without bleeding need not routinely trigger evaluation, although an individualized assessment based on patient characteristics and risk factors is appropriate. […] Transvaginal ultrasonography is not an appropriate screening tool for endometrial cancer in postmenopausal women without bleeding.

• #24 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. […] That’s a common thought voiced by patients of Jerry Lucas, MD, an OB/GYN for St. Josephs/Candler Physician Network, when they experience postmenopausal bleeding. […] 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. […] The first step is to confirm that we have met the definition of menopausean absence of menstruation for an entire year, Dr. Lucas explains. […] If the patient has met the definition of menopause, then it becomes Dr. Lucas investigation to see if endometrial cancer is the cause. […] A common cause of postmenopausal bleeding is endometrial atrophy, in which the lining of the uterus becomes thin and dry.

• #25 Prevalence of Hysteroscopic Findings in Postmenopausal Bleeding Patients and Its Correlation with Clinicohistopathologic Diagnosis

  https://www.jsafog.com/abstractArticleContentBrowse/JSAFOG/23535/JPJ/fullText

  On hysteroscopy, half the cases (n = 25; 50%) were diagnosed as polyps followed by atrophic endometrium (n = 8; 16%). There were 7 (14%) cases in whom the cervix was classified as unhealthy without any particular diagnosis. A total of 5 (10%) cases were diagnosed as fibroid, 1 (2%) each as hyperplasia and degenerative changes, and 3 (6%) as endometrial carcinoma. These findings are well correlate with clinicohistopathologic diagnosis. […] Hysteroscopy is an office procedure that can be performed as a daycare procedure, provides a better view of various structural pathologies, and in case of a doubtful pathology helps, in obtaining endometrial sample to confirm the diagnosis. Hysteroscopy helps to identify the women with PMB having an abnormal pathology from those who do not have any such pathology. Along with endometrial biopsy it is considered to be highly accurate in identification of endometrial neoplasia and its precursors. It has been considered to be the method of choice for evaluation of women with PMB especially those aged 45 years or above.

• #26 An Unwelcome Return

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

  Certain creams or estrogen products can exacerbate the problem and lead to bleeding. […] Some medications, such as blood thinners, can also be a cause, Dr. Lucas says. […] Postmenopausal women may also develop endometrial polyps. These are caused by the overgrowth of cells in the lining of the uterus, but they are usually benign, or non-cancerous. […] Treatment and management for postmenopausal bleeding will vary depending on its cause. […] Dr. Lucas urges patients not to wait to see a doctor if they experience this symptom, but also not to panic. […] An internet search might pop up with cancer and scare you to death, Dr. Lucas says. But it is not a common cause of postmenopausal bleeding. Visit your OB/GYN to get the definitive diagnosis.

• #27 Postmenopausal Bleeding: Role of Imaging in the Diagnosis and Management | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-030-69476-0_12

  Common causes of postmenopausal bleeding include endometrial atrophy, endometrial polyps, and endometrial hyperplasia. Some of these causes are readily diagnosed on ultrasound evaluation. The supplemental use of Saline infused sonohysterography adds to the diagnostic value of ultrasound assessment of the endometrium. Hysteroscopy allows direct visualization and guided biopsy and/or resection of endometrial lesions causing abnormal bleeding in selected cases. Magnetic resonance imaging is useful for the assessment of the endometrium for narrowing the differential diagnosis of endometrial abnormalities and for staging of endometrial cancers. Majority of the patients with vaginal bleeding actually bleed secondary to atrophic changes in the vagina or the endometrium.

• #28 Assessment of postmenopausal bleeding: a cohort case study – American Journal of Biomedicine

  https://ajbm.net/5870-2/

  The objective of this study is to assessment the postmenopausal bleeding (PMB), and investigated their causes, correlation with variable socio-demographic status. A 140-women complaining of PMB were enrolled in this study, each patient had a proper questionnaire filled in, with appropriate investigations that included; ultrasonography, Pap smear, colposcopy with cervical biopsy and endometrial curettage to take endometrial biopsy for histopathology. […] Various etiology of PMB were found in this study; endometrial cancer (9.3%), cervical cancer (0.7%), atrophic endometritis (7.1%), atrophic vaginitis (2.8%), endometrial hyperplasia (45%), Cervicitis-CIN (15.7%), cervical polyp (12.8%), and endometrial polyp (18.6%). […] The endometrial cancer present in 10% of the patients with recurrent PMB.

• #29 Can Bacterial Infection Cause Postmenopausal Bleeding?logo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na35462/2014/08/18/can-bacterial-infection-cause-postmenopausal-bleeding

  Vaginal ultrasound identifies intrauterine (intracavitary) fluid in almost 8% of patients with postmenopausal bleeding (PMB). […] To determine the prevalence and types of bacteria in endometrial aspirates from such patients, investigators at a Hong Kong clinic specializing in PMB conducted a retrospective cohort study of 228 women (mean age, 75) with PMB who presented with intracavitary fluid and no evidence of uterine tenderness or cervical masses. […] Although the authors conclude that benign PMB may be caused by intrauterine infection, they disregard the fact that many menopausal women without bleeding (e.g., asymptomatic women with adnexal cysts) who undergo vaginal ultrasound are found to have intracavitary fluid, which may simply reflect genital atrophy or cervical stenosis. […] Until a study is designed to compare microbiologic findings in intrauterine fluid from women with or without PMB, the clinical importance (if any) of positive cultures and antibiotic treatment remains uncertain.

• #30 :: JKMS :: Journal of Korean Medical Science

  https://jkms.org/DOIx.php?id=10.3346/jkms.2017.32.5.830

  The leading cause of PMB was vaginal or endometrial atrophy, but all the other causes were differently ranked. […] The incidence of endometrial cancer in Korea is increasing according to previous research. […] However, this study demonstrated that the incidence of PMB caused by endometrial cancer did not show significant change. […] Another notable change that appeared from our results is the decreased incidence in cervical cancer over the years. […] Last, HRT usage was shown to have increasing trend in the latter 5-year group. […] In conclusion, only the most common cause of PMB was the same as in previous data, while other causes were all ranked differently in Korean postmenopausal women.

• #31 First-time postmenopausal bleeding as a clinical marker of long-term cancer risk: A Danish Nationwide Cohort Study | British Journal of Cancer

  https://www.nature.com/articles/s41416-019-0668-2

  Data on long-term risk of cancer after a postmenopausal bleeding diagnosis are sparse. […] We therefore conducted a nationwide population-based cohort study to investigate the long-term risk of cancer and the particular risks of gynaecological, urological, gastrointestinal and haematological cancers after a first-time hospital diagnosis of PMB. […] In this Danish population-based study, we found that a first-time hospital-diagnosed PMB is a clinical marker of gynaecological, urological, gastrointestinal and haematological cancer. The risk of cancer was particularly high within the first three months of follow-up but remained elevated for several years after diagnosis for endometrial, bladder and ovarian cancer. […] In conclusion, a hospital-diagnosed PMB is a marker of a long-term risk of urogenital cancer in the Danish population. The sustained elevated SIR of ovarian and bladder cancer for several years after PMB diagnosis, suggest a need to broaden the diagnostic work-up in terms of normal gynaecological findings.

• #32 Azthena logo with the word Azthena

  https://www.news-medical.net/news/20240801/Study-Many-women-unaware-postmenopausal-bleeding-signals-endometrial-cancer.aspx

  Healthcare professionals appear to also be lacking in adequate education, because less than 50% of surveyed women reported that their healthcare professional had counseled them on postmenopausal bleeding. […] This survey study highlights opportunities for improved patient counseling about abnormal and postmenopausal uterine bleeding as an early warning sign of uterine cancer.

• #33 Postmenopausal bleeding: Don’t worry — but do call your doctor – Harvard Health

  https://www.health.harvard.edu/womens-health/postmenopausal-bleeding-dont-worry-but-do-call-your-doctor

  Bleeding indicates cancer only in a small percentage of cases, even though endometrial cancers are on the rise in American women. […] Although most postmenopausal bleeding is not caused by cancer, more than 90% of women with endometrial cancer have bleeding. […] Endometrial cancer, which affects 2% to 3% of American women, is the most common type of gynecological cancer. […] Identifying it early has become a pressing issue, because the incidence of this cancer has risen gradually but steadily over the past 10 years, according to the National Cancer Institute. […] Study authors said that their findings show that checking for endometrial cancer in women who experience postmenopausal bleeding could potentially find as many as 90% of these cancers. […] Investigate unusual bleeding early, because endometrial cancer is highly curable.

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

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

  Treatment for postmenopausal bleeding depends on its cause. […] When postmenopausal bleeding is diagnosed as endometrial cancer, most cases can be cured with a hysterectomy. […] Seeing a gynecologic oncologist immediately after diagnosis can avoid these complications, simplifying care and improving the chance of survival. […] Listen to your body. Alert your doctor to any changes or abnormal issues such as postmenopausal bleeding as soon as possible.

• #35 Postmenopausal Bleeding > Fact Sheets > Yale Medicine

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

  When a woman experiences postmenopausal bleeding, doctors should be able to diagnose the cause of her bleeding after obtaining a medical history, performing a physical exam, and running diagnostic tests. […] Treatment of postmenopausal bleeding is based on its cause. […] 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.

• #36 Abstract A061: Understanding health-seeking delays for post-menopausal bleeding among Haitian women – University of Miami

  https://scholarship.miami.edu/esploro/outputs/journalArticle/Abstract-A061-Understanding-health-seeking-delays-for/991031979495402976

  Black women have the highest risk of Endometrial cancer (EC) among any racial group in the US. […] The most common symptom of EC is postmenopausal bleeding (PMB). […] Little data exist about understanding/perception of PMB and subsequent care-seeking delays in this population of at-risk women. […] This study underscores the complexity of factors impacting potential help-seeking delays among Haitian women experiencing PMB. […] Our findings highlight the need for culturally-tailored, comprehensive educational interventions to increase awareness of the meaning of PMB and its health relevance to improve earlier care-seeking and timely diagnosis of EC.

• #37

  https://journals.lww.com/ogopen/fulltext/2025/02000/analysis_of_timely_follow_up_in_the_evaluation_of.2.aspx

  To characterize guideline-adherent follow-up in patients evaluated with transvaginal ultrasonography (TVUS) for postmenopausal bleeding. […] Of 1,671 patients with thickened endometrium, 307 (18.4%) did not receive prompt follow-up; of 389 patients with inadequately visualized endometrium, 128 (33.0%) did not receive prompt follow-up. […] Clinician misinterpretation of TVUS performed for postmenopausal bleeding was the most common reason for delayed or absent follow-up. […] Postmenopausal bleeding is the most common presentation of endometrial cancer. […] Since 2009, the American College of Obstetricians and Gynecologists (ACOG) has recommended either ultrasonography or biopsy-based evaluation of postmenopausal bleeding to rule out endometrial cancer. […] Given observed suboptimal rates of prompt follow-up after findings of thickened or inadequately visualized endometrium on ultrasonography and similar rates of an eventual cancer diagnosis in these cohorts, efforts should be focused on clinician understanding of ultrasonographic endometrial evaluation.

• #38 Postmenopausal Bleeding: A Blessing in Disguise | Dutta | Journal of Clinical Gynecology and Obstetrics

  https://jcgo.org/index.php/jcgo/article/view/286/144

  Postmenopausal bleeding (PMB) is associated with significant anxiety due to risk of malignancy in 5-25% of cases. […] The recommended age for cervical screening in England, Wales and Northern Ireland, is between 25 and 64 years. […] Approximately 60% of cervical cancers occur in women over the age of 45 years, and only 20% in women over the age of 65 years. […] There is evidence that a second spike of increased prevalence of High Risk HPV subtype occurs in postmenopausal women. […] High-risk HPV which is associated with low grade abnormality has a prevalence of 25% in women over the age of 50. […] In summary, postmenopausal women remain susceptible to HPV-related lower genital tract disease. […] Unfortunately, these women are not on the national cervical screening programme. […] In a rapidly growing elderly population, there should be some consideration for continued surveillance for cervical malignancy.

• #39

  https://journals.lww.com/ogopen/fulltext/2025/02000/analysis_of_timely_follow_up_in_the_evaluation_of.2.aspx

  To simplify the diagnostic process and reduce the risk of missing a cancer diagnosis, universal endometrial sampling for patients with postmenopausal bleeding could be considered. […] The observed rate of cancer diagnosis at 1 year, regardless of sampling timing, was 8.8% (95% CI, 7.5-10.3%) among patients with thickened endometrium and was 7.7% (95% CI, 5.3-10.9%) among those with inadequately visualized endometrium. […] The most common reason for lack of sampling of findings of inadequately visualized endometrium was that clinicians were reassured when the identified portion of the endometrium was less than 4 mm. […] Our results support that sampling is advisable due to the similar rate of cancer diagnosis as in those with a clearly thickened endometrium in our study.

• #40

  https://www.msjonline.org/index.php/ijrms/article/view/13570

  Postmenopausal bleeding (PMB) poses a diagnostic challenge due to the varied presentation of endometrial pathologies ranging from benign endometrial atrophy to the possibility of endometrial carcinoma. […] Although the incidence varies with patient characteristics, it warrants thorough evaluation. Risk factors such as obesity and hormone use should guide assessment. […] The optimal diagnostic strategy remains uncertain, necessitating focused research for enhanced accuracy. […] In summary, PMB warrants a systematic approach integrating imaging, histological assessment, and tailored therapy guided by risk factors, final diagnosis and patient preferences.

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