Materiały źródłowe

• #1 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

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

  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. […] 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. Oral hormone replacement and hormonal receptor modulators (eg, ospemifene) also may be considered if there is no improvement with other treatments. […] Thirty percent of PMB cases are caused by endometrial polyps; however, polyps can be asymptomatic. Furthermore, the severity of PMB is not affected by the number or size of polyps. One percent of all endometrial polyps are malignant, most commonly occurring in postmenopausal women. Therefore, endometrial polyps in symptomatic postmenopausal women should be removed and histologically assessed. Surgical excision should be considered in asymptomatic women at higher risk of malignancy (eg, large polyps, tamoxifen use, obesity, or diabetes). Hysteroscopic polypectomy is the preferred treatment because the clinician can obtain directed biopsies and excise polyps at once.

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

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

  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. […] 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. Oral hormone replacement and hormonal receptor modulators (eg, ospemifene) also may be considered if there is no improvement with other treatments. […] Thirty percent of PMB cases are caused by endometrial polyps; however, polyps can be asymptomatic. Furthermore, the severity of PMB is not affected by the number or size of polyps. One percent of all endometrial polyps are malignant, most commonly occurring in postmenopausal women. Therefore, endometrial polyps in symptomatic postmenopausal women should be removed and histologically assessed. Surgical excision should be considered in asymptomatic women at higher risk of malignancy (eg, large polyps, tamoxifen use, obesity, or diabetes). Hysteroscopic polypectomy is the preferred treatment because the clinician can obtain directed biopsies and excise polyps at once.

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

  https://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. […] Patients taking non-conventional MHT, such as troches and transdermal progestogen are at risk of endometrial hyperplasia and cancer. […] Bleeding should be investigated if it occurs after six months use of CCMHT or tibolone, or starts after amenorrhoea has been established on this regimen. […] When a localised or neoplastic lesion is found, the management is surgical. However, when the findings are benign and the patient is taking MHT, some modification of the MHT dose or regimen is required. […] 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.

• #4 Postmenopausal Bleeding > Fact Sheets > Yale Medicine

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

  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. […] Vaginal atrophy: Doctors may prescribe vaginal lubricants, topical hormones, or other medications to reduce vaginal dryness. […] Polyps or fibroids. If polyps or fibroids are the source of postmenopausal bleeding, surgery may be recommended to remove them. […] Hormone therapy. If the bleeding occurs because of hormone therapy, doctors may modify or suspend therapy. […] Infection. If an infection is identified, medications will be prescribed to eliminate the infection and stop future bleeding. […] Thick uterine lining. If postmenopausal bleeding happens because a woman has a thick uterine lining (endometrial hyperplasia), progestin therapy may be prescribed to trigger shedding of the uterine lining. Sometimes, doctors may remove the uterine lining surgically, during a dilation and curettage (DC) procedure.

• #5 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

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

  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. […] 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. Oral hormone replacement and hormonal receptor modulators (eg, ospemifene) also may be considered if there is no improvement with other treatments. […] Thirty percent of PMB cases are caused by endometrial polyps; however, polyps can be asymptomatic. Furthermore, the severity of PMB is not affected by the number or size of polyps. One percent of all endometrial polyps are malignant, most commonly occurring in postmenopausal women. Therefore, endometrial polyps in symptomatic postmenopausal women should be removed and histologically assessed. Surgical excision should be considered in asymptomatic women at higher risk of malignancy (eg, large polyps, tamoxifen use, obesity, or diabetes). Hysteroscopic polypectomy is the preferred treatment because the clinician can obtain directed biopsies and excise polyps at once.

• #6 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

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

  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. […] 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. Oral hormone replacement and hormonal receptor modulators (eg, ospemifene) also may be considered if there is no improvement with other treatments. […] Thirty percent of PMB cases are caused by endometrial polyps; however, polyps can be asymptomatic. Furthermore, the severity of PMB is not affected by the number or size of polyps. One percent of all endometrial polyps are malignant, most commonly occurring in postmenopausal women. Therefore, endometrial polyps in symptomatic postmenopausal women should be removed and histologically assessed. Surgical excision should be considered in asymptomatic women at higher risk of malignancy (eg, large polyps, tamoxifen use, obesity, or diabetes). Hysteroscopic polypectomy is the preferred treatment because the clinician can obtain directed biopsies and excise polyps at once.

• #7 Postmenopausal Bleeding > Fact Sheets > Yale Medicine

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

  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. […] Vaginal atrophy: Doctors may prescribe vaginal lubricants, topical hormones, or other medications to reduce vaginal dryness. […] Polyps or fibroids. If polyps or fibroids are the source of postmenopausal bleeding, surgery may be recommended to remove them. […] Hormone therapy. If the bleeding occurs because of hormone therapy, doctors may modify or suspend therapy. […] Infection. If an infection is identified, medications will be prescribed to eliminate the infection and stop future bleeding. […] Thick uterine lining. If postmenopausal bleeding happens because a woman has a thick uterine lining (endometrial hyperplasia), progestin therapy may be prescribed to trigger shedding of the uterine lining. Sometimes, doctors may remove the uterine lining surgically, during a dilation and curettage (DC) procedure.

• #8 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

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

  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. […] 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. Oral hormone replacement and hormonal receptor modulators (eg, ospemifene) also may be considered if there is no improvement with other treatments. […] Thirty percent of PMB cases are caused by endometrial polyps; however, polyps can be asymptomatic. Furthermore, the severity of PMB is not affected by the number or size of polyps. One percent of all endometrial polyps are malignant, most commonly occurring in postmenopausal women. Therefore, endometrial polyps in symptomatic postmenopausal women should be removed and histologically assessed. Surgical excision should be considered in asymptomatic women at higher risk of malignancy (eg, large polyps, tamoxifen use, obesity, or diabetes). Hysteroscopic polypectomy is the preferred treatment because the clinician can obtain directed biopsies and excise polyps at once.

• #9 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

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

  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. […] 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. Oral hormone replacement and hormonal receptor modulators (eg, ospemifene) also may be considered if there is no improvement with other treatments. […] Thirty percent of PMB cases are caused by endometrial polyps; however, polyps can be asymptomatic. Furthermore, the severity of PMB is not affected by the number or size of polyps. One percent of all endometrial polyps are malignant, most commonly occurring in postmenopausal women. Therefore, endometrial polyps in symptomatic postmenopausal women should be removed and histologically assessed. Surgical excision should be considered in asymptomatic women at higher risk of malignancy (eg, large polyps, tamoxifen use, obesity, or diabetes). Hysteroscopic polypectomy is the preferred treatment because the clinician can obtain directed biopsies and excise polyps at once.

• #10 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

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

  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. […] 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. Oral hormone replacement and hormonal receptor modulators (eg, ospemifene) also may be considered if there is no improvement with other treatments. […] Thirty percent of PMB cases are caused by endometrial polyps; however, polyps can be asymptomatic. Furthermore, the severity of PMB is not affected by the number or size of polyps. One percent of all endometrial polyps are malignant, most commonly occurring in postmenopausal women. Therefore, endometrial polyps in symptomatic postmenopausal women should be removed and histologically assessed. Surgical excision should be considered in asymptomatic women at higher risk of malignancy (eg, large polyps, tamoxifen use, obesity, or diabetes). Hysteroscopic polypectomy is the preferred treatment because the clinician can obtain directed biopsies and excise polyps at once.

• #11 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

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

  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. […] 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. Oral hormone replacement and hormonal receptor modulators (eg, ospemifene) also may be considered if there is no improvement with other treatments. […] Thirty percent of PMB cases are caused by endometrial polyps; however, polyps can be asymptomatic. Furthermore, the severity of PMB is not affected by the number or size of polyps. One percent of all endometrial polyps are malignant, most commonly occurring in postmenopausal women. Therefore, endometrial polyps in symptomatic postmenopausal women should be removed and histologically assessed. Surgical excision should be considered in asymptomatic women at higher risk of malignancy (eg, large polyps, tamoxifen use, obesity, or diabetes). Hysteroscopic polypectomy is the preferred treatment because the clinician can obtain directed biopsies and excise polyps at once.

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

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

  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. […] 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. Oral hormone replacement and hormonal receptor modulators (eg, ospemifene) also may be considered if there is no improvement with other treatments. […] Thirty percent of PMB cases are caused by endometrial polyps; however, polyps can be asymptomatic. Furthermore, the severity of PMB is not affected by the number or size of polyps. One percent of all endometrial polyps are malignant, most commonly occurring in postmenopausal women. Therefore, endometrial polyps in symptomatic postmenopausal women should be removed and histologically assessed. Surgical excision should be considered in asymptomatic women at higher risk of malignancy (eg, large polyps, tamoxifen use, obesity, or diabetes). Hysteroscopic polypectomy is the preferred treatment because the clinician can obtain directed biopsies and excise polyps at once.

• #12 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

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

  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. […] 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. Oral hormone replacement and hormonal receptor modulators (eg, ospemifene) also may be considered if there is no improvement with other treatments. […] Thirty percent of PMB cases are caused by endometrial polyps; however, polyps can be asymptomatic. Furthermore, the severity of PMB is not affected by the number or size of polyps. One percent of all endometrial polyps are malignant, most commonly occurring in postmenopausal women. Therefore, endometrial polyps in symptomatic postmenopausal women should be removed and histologically assessed. Surgical excision should be considered in asymptomatic women at higher risk of malignancy (eg, large polyps, tamoxifen use, obesity, or diabetes). Hysteroscopic polypectomy is the preferred treatment because the clinician can obtain directed biopsies and excise polyps at once.

• #13 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

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

  Typically, leiomyomas (ie, fibroids) are benign and regress during menopause and may not need treatment if patients are asymptomatic. A small percentage of fibroids are malignant, primarily in postmenopausal women. Occasionally, benign leiomyomas may grow or become symptomatic even in postmenopausal patients, particularly in obese women, due to peripheral conversion of estrogen from adipose stores. In women with PMB found to have uterine fibroids with an otherwise normal evaluation, pharmacologic (eg, aromatase inhibitors and selective estrogen receptor modulators) or surgical (eg, myomectomy and hysterectomy) therapy may be considered. […] For sexually transmitted diseases and other genital infections, treatment is guided by vaginal culture results. Clinicians may consider oral doxycycline to treat endometritis.

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

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

  Typically, leiomyomas (ie, fibroids) are benign and regress during menopause and may not need treatment if patients are asymptomatic. A small percentage of fibroids are malignant, primarily in postmenopausal women. Occasionally, benign leiomyomas may grow or become symptomatic even in postmenopausal patients, particularly in obese women, due to peripheral conversion of estrogen from adipose stores. In women with PMB found to have uterine fibroids with an otherwise normal evaluation, pharmacologic (eg, aromatase inhibitors and selective estrogen receptor modulators) or surgical (eg, myomectomy and hysterectomy) therapy may be considered. […] For sexually transmitted diseases and other genital infections, treatment is guided by vaginal culture results. Clinicians may consider oral doxycycline to treat endometritis.

• #15 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

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

  Typically, leiomyomas (ie, fibroids) are benign and regress during menopause and may not need treatment if patients are asymptomatic. A small percentage of fibroids are malignant, primarily in postmenopausal women. Occasionally, benign leiomyomas may grow or become symptomatic even in postmenopausal patients, particularly in obese women, due to peripheral conversion of estrogen from adipose stores. In women with PMB found to have uterine fibroids with an otherwise normal evaluation, pharmacologic (eg, aromatase inhibitors and selective estrogen receptor modulators) or surgical (eg, myomectomy and hysterectomy) therapy may be considered. […] For sexually transmitted diseases and other genital infections, treatment is guided by vaginal culture results. Clinicians may consider oral doxycycline to treat endometritis.

• #16 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

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

  Typically, leiomyomas (ie, fibroids) are benign and regress during menopause and may not need treatment if patients are asymptomatic. A small percentage of fibroids are malignant, primarily in postmenopausal women. Occasionally, benign leiomyomas may grow or become symptomatic even in postmenopausal patients, particularly in obese women, due to peripheral conversion of estrogen from adipose stores. In women with PMB found to have uterine fibroids with an otherwise normal evaluation, pharmacologic (eg, aromatase inhibitors and selective estrogen receptor modulators) or surgical (eg, myomectomy and hysterectomy) therapy may be considered. […] For sexually transmitted diseases and other genital infections, treatment is guided by vaginal culture results. Clinicians may consider oral doxycycline to treat endometritis.

• #17 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

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

  Endometrial hyperplasia is classified as benign endometrial hyperplasia or intraepithelial neoplasia. Management of hyperplasia consists of surgical and nonsurgical therapies; the treatment approach is individualized based on clinical factors (eg, comorbid conditions). However, endometrial carcinoma requires surgical treatment and staging by gynecologic oncology specialists. Additionally, chemotherapy and radiation may be indicated for some patients. […] Benign endometrial hyperplasia: Also referred to as nonatypical endometrial hyperplasia, this type of hyperplasia is typically managed with hormonal therapy and/or curettage. […] Endometrial intraepithelial neoplasia: The approach to treatment depends on various clinical factors, including patient preferences. Generally, in postmenopausal women, fertility conservation is not desired; therefore, minimally invasive hysterectomy with bilateral salpingectomy is the preferred treatment. Shared decision-making should be utilized when determining if bilateral oophorectomy is also performed. Medical management is an option for patients who are declining surgery or are poor surgical candidates. […] Definitive treatment with hysterectomy and comprehensive staging is the standard of care. Prognosis and appropriate adjuvant therapy are determined by staging.

• #18 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

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

  Endometrial hyperplasia is classified as benign endometrial hyperplasia or intraepithelial neoplasia. Management of hyperplasia consists of surgical and nonsurgical therapies; the treatment approach is individualized based on clinical factors (eg, comorbid conditions). However, endometrial carcinoma requires surgical treatment and staging by gynecologic oncology specialists. Additionally, chemotherapy and radiation may be indicated for some patients. […] Benign endometrial hyperplasia: Also referred to as nonatypical endometrial hyperplasia, this type of hyperplasia is typically managed with hormonal therapy and/or curettage. […] Endometrial intraepithelial neoplasia: The approach to treatment depends on various clinical factors, including patient preferences. Generally, in postmenopausal women, fertility conservation is not desired; therefore, minimally invasive hysterectomy with bilateral salpingectomy is the preferred treatment. Shared decision-making should be utilized when determining if bilateral oophorectomy is also performed. Medical management is an option for patients who are declining surgery or are poor surgical candidates. […] Definitive treatment with hysterectomy and comprehensive staging is the standard of care. Prognosis and appropriate adjuvant therapy are determined by staging.

• #19 Postmenopausal Bleeding: Causes and Treatments

  https://www.webmd.com/menopause/postmenopausal-bleeding

  How Is It Treated? […] That depends on whats causing the bleeding. […] Estrogen therapy: This hormone is used to treat vaginal and endometrial atrophy. Your doctor may prescribe it in one of the following forms: […] Progestin therapy: This lab-made version of progesterone is used to treat endometrial hyperplasia. Your doctor may prescribe it in a pill or shot, a vaginal cream, or intrauterine device. […] Hysteroscopy: This procedure can remove polyps. Doctors also use it to remove thickened parts of the uterine lining caused by endometrial hyperplasia. […] DC (dilation and curettage): In this surgery, the doctor opens your cervix. (You may hear them say they are going to dilate it). They use a thin tool to remove polyps or thickened areas of the uterine lining caused by endometrial hyperplasia.

• #20 Postmenopausal Bleeding: Causes and Treatments

  https://www.webmd.com/menopause/postmenopausal-bleeding

  How Is It Treated? […] That depends on whats causing the bleeding. […] Estrogen therapy: This hormone is used to treat vaginal and endometrial atrophy. Your doctor may prescribe it in one of the following forms: […] Progestin therapy: This lab-made version of progesterone is used to treat endometrial hyperplasia. Your doctor may prescribe it in a pill or shot, a vaginal cream, or intrauterine device. […] Hysteroscopy: This procedure can remove polyps. Doctors also use it to remove thickened parts of the uterine lining caused by endometrial hyperplasia. […] DC (dilation and curettage): In this surgery, the doctor opens your cervix. (You may hear them say they are going to dilate it). They use a thin tool to remove polyps or thickened areas of the uterine lining caused by endometrial hyperplasia.

• #21 Postmenopausal Bleeding: Causes and Treatments

  https://www.webmd.com/menopause/postmenopausal-bleeding

  How Is It Treated? […] That depends on whats causing the bleeding. […] Estrogen therapy: This hormone is used to treat vaginal and endometrial atrophy. Your doctor may prescribe it in one of the following forms: […] Progestin therapy: This lab-made version of progesterone is used to treat endometrial hyperplasia. Your doctor may prescribe it in a pill or shot, a vaginal cream, or intrauterine device. […] Hysteroscopy: This procedure can remove polyps. Doctors also use it to remove thickened parts of the uterine lining caused by endometrial hyperplasia. […] DC (dilation and curettage): In this surgery, the doctor opens your cervix. (You may hear them say they are going to dilate it). They use a thin tool to remove polyps or thickened areas of the uterine lining caused by endometrial hyperplasia.

• #22 Abnormal (Dysfunctional) Uterine Bleeding Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/257007-treatment

  Levonorgestrel-releasing intrauterine system is considered a first-line treatment for adolescents with heavy menstrual bleeding. […] Intravenous estrogen alone is indicated in emergent clinical situations requiring hospitalization but with a clinically stable patient. […] Prolonged uterine bleeding suggests the epithelial lining of the cavity has become denuded over time. […] Chronic management of AUB requires episodic or continuous exposure to a progestin. […] In patients with a pill contraindication, cyclic progestin for 12 days per month using medroxyprogesterone acetate (10 mg/d) or norethindrone acetate (2.5-5 mg/d) provides predictable uterine withdrawal bleeding, but not contraception. […] Endometrial ablation is an alternative for those who wish to avoid hysterectomy or who are not candidates for major surgery. […] The ablation procedure is more conservative than hysterectomy and has a shorter recovery time. […] Endometrial ablation is not an optimal choice in women with adenomyosis or uncorrected submucosal fibroids.

• #22 Postmenopausal Bleeding: Causes and Treatments

  https://www.webmd.com/menopause/postmenopausal-bleeding

  How Is It Treated? […] That depends on whats causing the bleeding. […] Estrogen therapy: This hormone is used to treat vaginal and endometrial atrophy. Your doctor may prescribe it in one of the following forms: […] Progestin therapy: This lab-made version of progesterone is used to treat endometrial hyperplasia. Your doctor may prescribe it in a pill or shot, a vaginal cream, or intrauterine device. […] Hysteroscopy: This procedure can remove polyps. Doctors also use it to remove thickened parts of the uterine lining caused by endometrial hyperplasia. […] DC (dilation and curettage): In this surgery, the doctor opens your cervix. (You may hear them say they are going to dilate it). They use a thin tool to remove polyps or thickened areas of the uterine lining caused by endometrial hyperplasia.

• #23 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

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

  Endometrial hyperplasia is classified as benign endometrial hyperplasia or intraepithelial neoplasia. Management of hyperplasia consists of surgical and nonsurgical therapies; the treatment approach is individualized based on clinical factors (eg, comorbid conditions). However, endometrial carcinoma requires surgical treatment and staging by gynecologic oncology specialists. Additionally, chemotherapy and radiation may be indicated for some patients. […] Benign endometrial hyperplasia: Also referred to as nonatypical endometrial hyperplasia, this type of hyperplasia is typically managed with hormonal therapy and/or curettage. […] Endometrial intraepithelial neoplasia: The approach to treatment depends on various clinical factors, including patient preferences. Generally, in postmenopausal women, fertility conservation is not desired; therefore, minimally invasive hysterectomy with bilateral salpingectomy is the preferred treatment. Shared decision-making should be utilized when determining if bilateral oophorectomy is also performed. Medical management is an option for patients who are declining surgery or are poor surgical candidates. […] Definitive treatment with hysterectomy and comprehensive staging is the standard of care. Prognosis and appropriate adjuvant therapy are determined by staging.

• #24 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

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

  Endometrial hyperplasia is classified as benign endometrial hyperplasia or intraepithelial neoplasia. Management of hyperplasia consists of surgical and nonsurgical therapies; the treatment approach is individualized based on clinical factors (eg, comorbid conditions). However, endometrial carcinoma requires surgical treatment and staging by gynecologic oncology specialists. Additionally, chemotherapy and radiation may be indicated for some patients. […] Benign endometrial hyperplasia: Also referred to as nonatypical endometrial hyperplasia, this type of hyperplasia is typically managed with hormonal therapy and/or curettage. […] Endometrial intraepithelial neoplasia: The approach to treatment depends on various clinical factors, including patient preferences. Generally, in postmenopausal women, fertility conservation is not desired; therefore, minimally invasive hysterectomy with bilateral salpingectomy is the preferred treatment. Shared decision-making should be utilized when determining if bilateral oophorectomy is also performed. Medical management is an option for patients who are declining surgery or are poor surgical candidates. […] Definitive treatment with hysterectomy and comprehensive staging is the standard of care. Prognosis and appropriate adjuvant therapy are determined by staging.

• #25 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

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

  Endometrial hyperplasia is classified as benign endometrial hyperplasia or intraepithelial neoplasia. Management of hyperplasia consists of surgical and nonsurgical therapies; the treatment approach is individualized based on clinical factors (eg, comorbid conditions). However, endometrial carcinoma requires surgical treatment and staging by gynecologic oncology specialists. Additionally, chemotherapy and radiation may be indicated for some patients. […] Benign endometrial hyperplasia: Also referred to as nonatypical endometrial hyperplasia, this type of hyperplasia is typically managed with hormonal therapy and/or curettage. […] Endometrial intraepithelial neoplasia: The approach to treatment depends on various clinical factors, including patient preferences. Generally, in postmenopausal women, fertility conservation is not desired; therefore, minimally invasive hysterectomy with bilateral salpingectomy is the preferred treatment. Shared decision-making should be utilized when determining if bilateral oophorectomy is also performed. Medical management is an option for patients who are declining surgery or are poor surgical candidates. […] Definitive treatment with hysterectomy and comprehensive staging is the standard of care. Prognosis and appropriate adjuvant therapy are determined by staging.

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

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

  Endometrial hyperplasia is classified as benign endometrial hyperplasia or intraepithelial neoplasia. Management of hyperplasia consists of surgical and nonsurgical therapies; the treatment approach is individualized based on clinical factors (eg, comorbid conditions). However, endometrial carcinoma requires surgical treatment and staging by gynecologic oncology specialists. Additionally, chemotherapy and radiation may be indicated for some patients. […] Benign endometrial hyperplasia: Also referred to as nonatypical endometrial hyperplasia, this type of hyperplasia is typically managed with hormonal therapy and/or curettage. […] Endometrial adenocarcinoma: Definitive treatment with hysterectomy and comprehensive staging is the standard of care. Prognosis and appropriate adjuvant therapy are determined by staging.

• #27 Postmenopausal Bleeding > Fact Sheets > Yale Medicine

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

  Endometrial cancer. If a woman is diagnosed with endometrial cancer, surgical removal of the uterus (hysterectomy), often along with the ovaries and fallopian tubes, may be needed. Local lymph nodes may also be biopsied to see if the cancer has spread. A woman may receive chemotherapy or radiation after surgery, depending on the circumstances of her diagnosis.

• #28 Postmenopausal bleeding

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

  Postmenopausal bleeding is not usually serious, but can be a sign of cancer. Cancer may be easier to treat if it’s found early. […] Treatment for postmenopausal bleeding depends on what’s causing it. […] The polyps may need to be removed by a specialist. […] You may not need treatment, but may be offered oestrogen cream or pessaries. […] Depending on the type of hyperplasia, you may be offered no treatment, hormone medicine (tablets or an intrauterine system, IUS) or a total hysterectomy (surgery to remove your uterus, cervix and ovaries). […] Changing or stopping HRT treatment. […] Total hysterectomy will often be recommended, often followed by radiotherapy, chemotherapy, or hormone therapy, or a combination of treatments. […] Surgery to remove your ovaries, and sometimes your womb (total hysterectomy). You may also have chemotherapy.

• #29 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

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

  Typically, leiomyomas (ie, fibroids) are benign and regress during menopause and may not need treatment if patients are asymptomatic. A small percentage of fibroids are malignant, primarily in postmenopausal women. Occasionally, benign leiomyomas may grow or become symptomatic even in postmenopausal patients, particularly in obese women, due to peripheral conversion of estrogen from adipose stores. In women with PMB found to have uterine fibroids with an otherwise normal evaluation, pharmacologic (eg, aromatase inhibitors and selective estrogen receptor modulators) or surgical (eg, myomectomy and hysterectomy) therapy may be considered. […] For sexually transmitted diseases and other genital infections, treatment is guided by vaginal culture results. Clinicians may consider oral doxycycline to treat endometritis.

• #30 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 most cases, postmenopausal bleeding is due to benign (noncancerous) conditions and isnt a cause for worry. […] Talk to your healthcare provider if you experience any bleeding after menopause. […] Contact your healthcare provider if you experience bleeding after menopause as it could be a sign of a medical condition. […] Treatment for postmenopausal bleeding depends on its cause. Medication and surgery are the most common treatments. […] Medications include: Antibiotics treat most infections. Estrogen: Taking supplemental estrogen helps bleeding due to vaginal atrophy. […] Progestin treats endometrial hyperplasia by triggering your uterus to shed its lining. […] Surgical treatment includes: Hysteroscopy: This procedure allows providers to diagnose and treat causes of uterine bleeding like polyps or growths.

• #31 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

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

  Typically, leiomyomas (ie, fibroids) are benign and regress during menopause and may not need treatment if patients are asymptomatic. A small percentage of fibroids are malignant, primarily in postmenopausal women. Occasionally, benign leiomyomas may grow or become symptomatic even in postmenopausal patients, particularly in obese women, due to peripheral conversion of estrogen from adipose stores. In women with PMB found to have uterine fibroids with an otherwise normal evaluation, pharmacologic (eg, aromatase inhibitors and selective estrogen receptor modulators) or surgical (eg, myomectomy and hysterectomy) therapy may be considered. […] For sexually transmitted diseases and other genital infections, treatment is guided by vaginal culture results. Clinicians may consider oral doxycycline to treat endometritis.

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

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

  Postmenopausal hormone replacement therapy frequently causes PMB for the first 2 to 3 months after initiation, which spontaneously resolves in most women. However, clinicians should evaluate for endometrial pathology in women with persistent or recurrent PMB following the first few months of therapy. For anticoagulants leading to vaginal bleeding, progestin therapy may improve bleeding until anticoagulants can be discontinued. Longer-term solutions may need to be discussed in patients on lifelong anticoagulation.

• #33 Postmenopausal Bleeding > Fact Sheets > Yale Medicine

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

  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. […] Vaginal atrophy: Doctors may prescribe vaginal lubricants, topical hormones, or other medications to reduce vaginal dryness. […] Polyps or fibroids. If polyps or fibroids are the source of postmenopausal bleeding, surgery may be recommended to remove them. […] Hormone therapy. If the bleeding occurs because of hormone therapy, doctors may modify or suspend therapy. […] Infection. If an infection is identified, medications will be prescribed to eliminate the infection and stop future bleeding. […] Thick uterine lining. If postmenopausal bleeding happens because a woman has a thick uterine lining (endometrial hyperplasia), progestin therapy may be prescribed to trigger shedding of the uterine lining. Sometimes, doctors may remove the uterine lining surgically, during a dilation and curettage (DC) procedure.

• #34 Postmenopausal bleeding

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

  Postmenopausal bleeding is not usually serious, but can be a sign of cancer. Cancer may be easier to treat if it’s found early. […] Treatment for postmenopausal bleeding depends on what’s causing it. […] The polyps may need to be removed by a specialist. […] You may not need treatment, but may be offered oestrogen cream or pessaries. […] Depending on the type of hyperplasia, you may be offered no treatment, hormone medicine (tablets or an intrauterine system, IUS) or a total hysterectomy (surgery to remove your uterus, cervix and ovaries). […] Changing or stopping HRT treatment. […] Total hysterectomy will often be recommended, often followed by radiotherapy, chemotherapy, or hormone therapy, or a combination of treatments. […] Surgery to remove your ovaries, and sometimes your womb (total hysterectomy). You may also have chemotherapy.

• #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/

  In women using sequential HRT (sHRT), offer a minimum of 10 days norethisterone (NET) or medroxyprogesterone acetate (MPA), or 12 days of micronised progesterone, per month. […] Women taking a sequential preparation (sHRT) over the age of 45 should be offered, after five years of use or by age 54 (whichever comes first), a change to continuous combined (ccHRT). […] 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. […] If unscheduled bleeding continues in low-risk women, after six months of adjustments, discuss the options of an urgent ultrasound (within six weeks) versus weaning off HRT and consideration of non-hormonal alternatives (to avoid invasive investigations).

• #36 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 most cases, postmenopausal bleeding is due to benign (noncancerous) conditions and isnt a cause for worry. […] Talk to your healthcare provider if you experience any bleeding after menopause. […] Contact your healthcare provider if you experience bleeding after menopause as it could be a sign of a medical condition. […] Treatment for postmenopausal bleeding depends on its cause. Medication and surgery are the most common treatments. […] Medications include: Antibiotics treat most infections. Estrogen: Taking supplemental estrogen helps bleeding due to vaginal atrophy. […] Progestin treats endometrial hyperplasia by triggering your uterus to shed its lining. […] Surgical treatment includes: Hysteroscopy: This procedure allows providers to diagnose and treat causes of uterine bleeding like polyps or growths.

• #37 Postmenopausal Bleeding: Causes and Treatments

  https://www.webmd.com/menopause/postmenopausal-bleeding

  How Is It Treated? […] That depends on whats causing the bleeding. […] Estrogen therapy: This hormone is used to treat vaginal and endometrial atrophy. Your doctor may prescribe it in one of the following forms: […] Progestin therapy: This lab-made version of progesterone is used to treat endometrial hyperplasia. Your doctor may prescribe it in a pill or shot, a vaginal cream, or intrauterine device. […] Hysteroscopy: This procedure can remove polyps. Doctors also use it to remove thickened parts of the uterine lining caused by endometrial hyperplasia. […] DC (dilation and curettage): In this surgery, the doctor opens your cervix. (You may hear them say they are going to dilate it). They use a thin tool to remove polyps or thickened areas of the uterine lining caused by endometrial hyperplasia.

• #38

• #39 Postmenopausal Bleeding: Causes, Diagnosis & Treatment

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

  Dilation and curettage (DC): This is a procedure to remove the lining and contents of your uterus. […] Hysterectomy: This is a surgery to remove your uterus and cervix. […] Contact your healthcare provider if you experience any vaginal bleeding: More than a year after your last menstrual period. […] In most cases, vaginal bleeding after menopause is harmless. But it can be a sign of a more serious condition.

• #40 Postmenopausal Bleeding > Fact Sheets > Yale Medicine

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

  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. […] Vaginal atrophy: Doctors may prescribe vaginal lubricants, topical hormones, or other medications to reduce vaginal dryness. […] Polyps or fibroids. If polyps or fibroids are the source of postmenopausal bleeding, surgery may be recommended to remove them. […] Hormone therapy. If the bleeding occurs because of hormone therapy, doctors may modify or suspend therapy. […] Infection. If an infection is identified, medications will be prescribed to eliminate the infection and stop future bleeding. […] Thick uterine lining. If postmenopausal bleeding happens because a woman has a thick uterine lining (endometrial hyperplasia), progestin therapy may be prescribed to trigger shedding of the uterine lining. Sometimes, doctors may remove the uterine lining surgically, during a dilation and curettage (DC) procedure.

• #41 Postmenopausal Bleeding: Causes, Diagnosis & Treatment

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

  Dilation and curettage (DC): This is a procedure to remove the lining and contents of your uterus. […] Hysterectomy: This is a surgery to remove your uterus and cervix. […] Contact your healthcare provider if you experience any vaginal bleeding: More than a year after your last menstrual period. […] In most cases, vaginal bleeding after menopause is harmless. But it can be a sign of a more serious condition.

• #42 Postmenopausal Bleeding: Causes and Treatments

  https://www.webmd.com/menopause/postmenopausal-bleeding

  Hysterectomy: This surgery removes part or all of your uterus. Its a treatment for endometrial or cervical cancer. Some people with a precancerous form of endometrial hyperplasia may also need it. In some cases, the doctor may also take out your ovaries, fallopian tubes, or nearby lymph nodes. […] Radiation, chemotherapy, and hormone therapy: You may need more cancer treatment after surgery. Your doctor will prescribe one based on what type of cancer you have and what stage its in. […] Medications: Your doctor can prescribe drugs like antibiotics for sexually transmitted diseases. They can also treat cervical or uterine infections.

• #43 Postmenopausal Bleeding: Causes and Treatments

  https://www.webmd.com/menopause/postmenopausal-bleeding

  Hysterectomy: This surgery removes part or all of your uterus. Its a treatment for endometrial or cervical cancer. Some people with a precancerous form of endometrial hyperplasia may also need it. In some cases, the doctor may also take out your ovaries, fallopian tubes, or nearby lymph nodes. […] Radiation, chemotherapy, and hormone therapy: You may need more cancer treatment after surgery. Your doctor will prescribe one based on what type of cancer you have and what stage its in. […] Medications: Your doctor can prescribe drugs like antibiotics for sexually transmitted diseases. They can also treat cervical or uterine infections.

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

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

  Postmenopausal hormone replacement therapy frequently causes PMB for the first 2 to 3 months after initiation, which spontaneously resolves in most women. However, clinicians should evaluate for endometrial pathology in women with persistent or recurrent PMB following the first few months of therapy. For anticoagulants leading to vaginal bleeding, progestin therapy may improve bleeding until anticoagulants can be discontinued. Longer-term solutions may need to be discussed in patients on lifelong anticoagulation.

• #45 Abnormal Uterine Bleeding: Postmenopausal and Menopausal Transition | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688239/all/Abnormal_Uterine_Bleeding:_Postmenopausal_and_Menopausal_Transition

  Depot medroxyprogesterone acetate 150 mg every 1 to 3 months, Levonorgestrel IUD, Combined hormonal contraceptives. […] Nonhormonal options to reduce heavy AUB: Tranexamic acid 1,300 mg PO taken 3 times daily for first 5 days of cycle, beginning with bleeding onset. […] Comparable to hormonal therapies. […] Consider patients individual risk for thromboembolic disease, breast cancer, and gastrointestinal bleeding. […] Polypectomy or myomectomy can reduce 75-100% of symptomatic bleeding. […] Hysterectomy indicated if premalignant or malignant lesions are identified during workup of AUB.

• #46 Postmenopausal Bleeding: Causes and Treatments

  https://www.webmd.com/menopause/postmenopausal-bleeding

  How Is It Treated? […] That depends on whats causing the bleeding. […] Estrogen therapy: This hormone is used to treat vaginal and endometrial atrophy. Your doctor may prescribe it in one of the following forms: […] Progestin therapy: This lab-made version of progesterone is used to treat endometrial hyperplasia. Your doctor may prescribe it in a pill or shot, a vaginal cream, or intrauterine device. […] Hysteroscopy: This procedure can remove polyps. Doctors also use it to remove thickened parts of the uterine lining caused by endometrial hyperplasia. […] DC (dilation and curettage): In this surgery, the doctor opens your cervix. (You may hear them say they are going to dilate it). They use a thin tool to remove polyps or thickened areas of the uterine lining caused by endometrial hyperplasia.

• #47 Postmenopausal bleeding: Causes, diagnosis, and treatment

  https://www.medicalnewstoday.com/articles/317624

  Postmenopausal bleeding can stem from a range of issues. […] Treatments for postmenopausal bleeding will depend on the cause. […] A doctor can consider the information gathered from the testing to work out the best course of treatment. Some examples of treatments for specific underlying causes include: […] Bleeding usually resolves on its own, but a doctor may recommend treatment to protect the vagina, such as: […] Treatment options include hormonal medications known as progestins. These can help prevent the endometrial lining from becoming too thick. […] If tests show that endometrial cancer is present, a doctor will recommend an appropriate treatment plan. […] Treatment of polyps may include surgical removal of the polyps so they can no longer bleed. […] A doctor may remove or ablate fibroids during a hysteroscopy. If this does not help and fibroids are troublesome, the person may undergo a hysterectomy. […] If a bacterial infection is present, a doctor will prescribe antibiotics.

• #48 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. […] 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. […] When postmenopausal bleeding is diagnosed as endometrial cancer, most cases can be cured with a hysterectomy. However, because endometrial cancer can spread into the lymph nodes, many patients also should have a lymph node dissection at the time of hysterectomy.

• #49 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 most cases, postmenopausal bleeding is due to benign (noncancerous) conditions and isnt a cause for worry. […] Talk to your healthcare provider if you experience any bleeding after menopause. […] Contact your healthcare provider if you experience bleeding after menopause as it could be a sign of a medical condition. […] Treatment for postmenopausal bleeding depends on its cause. Medication and surgery are the most common treatments. […] Medications include: Antibiotics treat most infections. Estrogen: Taking supplemental estrogen helps bleeding due to vaginal atrophy. […] Progestin treats endometrial hyperplasia by triggering your uterus to shed its lining. […] Surgical treatment includes: Hysteroscopy: This procedure allows providers to diagnose and treat causes of uterine bleeding like polyps or growths.

• #50 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 most cases, postmenopausal bleeding is due to benign (noncancerous) conditions and isnt a cause for worry. […] Talk to your healthcare provider if you experience any bleeding after menopause. […] Contact your healthcare provider if you experience bleeding after menopause as it could be a sign of a medical condition. […] Treatment for postmenopausal bleeding depends on its cause. Medication and surgery are the most common treatments. […] Medications include: Antibiotics treat most infections. Estrogen: Taking supplemental estrogen helps bleeding due to vaginal atrophy. […] Progestin treats endometrial hyperplasia by triggering your uterus to shed its lining. […] Surgical treatment includes: Hysteroscopy: This procedure allows providers to diagnose and treat causes of uterine bleeding like polyps or growths.

• #51 Postmenopausal Bleeding: Causes and Treatments

  https://www.webmd.com/menopause/postmenopausal-bleeding

  How Is It Treated? […] That depends on whats causing the bleeding. […] Estrogen therapy: This hormone is used to treat vaginal and endometrial atrophy. Your doctor may prescribe it in one of the following forms: […] Progestin therapy: This lab-made version of progesterone is used to treat endometrial hyperplasia. Your doctor may prescribe it in a pill or shot, a vaginal cream, or intrauterine device. […] Hysteroscopy: This procedure can remove polyps. Doctors also use it to remove thickened parts of the uterine lining caused by endometrial hyperplasia. […] DC (dilation and curettage): In this surgery, the doctor opens your cervix. (You may hear them say they are going to dilate it). They use a thin tool to remove polyps or thickened areas of the uterine lining caused by endometrial hyperplasia.

• #52 Abnormal Uterine Bleeding: Postmenopausal and Menopausal Transition | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688239/all/Abnormal_Uterine_Bleeding:_Postmenopausal_and_Menopausal_Transition

  For patients in MT, not indicated in postmenopausal (see surgical options): bleeding at this time is likely anovulatory due to paucity of progesterone in the second half of the cycle, leading to unopposed estrogen; raises the concern for endometrial hyperplasia, which must be ruled out prior to hormonal therapy. […] Goal of therapy is to stabilize the endometrium with progesterone. This can also help regulate the cycle and minimize other associated menopausal symptoms if present. […] No real consensus in the literature on best therapy out of choices listed below or length of therapy (6 to 12 months prior to discontinuing is reasonable). […] Progestin-only oral therapy (for symptom control only, no contraceptive coverage): Medroxyprogesterone acetate 10 mg PO daily for 14 days each month, Megestrol acetate 40 mg PO daily, Norethindrone acetate 2.5 to 10.0 mg PO daily times 5 to 10 days each cycle.

• #53 Abnormal Uterine Bleeding: Postmenopausal and Menopausal Transition | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688239/all/Abnormal_Uterine_Bleeding:_Postmenopausal_and_Menopausal_Transition

  Depot medroxyprogesterone acetate 150 mg every 1 to 3 months, Levonorgestrel IUD, Combined hormonal contraceptives. […] Nonhormonal options to reduce heavy AUB: Tranexamic acid 1,300 mg PO taken 3 times daily for first 5 days of cycle, beginning with bleeding onset. […] Comparable to hormonal therapies. […] Consider patients individual risk for thromboembolic disease, breast cancer, and gastrointestinal bleeding. […] Polypectomy or myomectomy can reduce 75-100% of symptomatic bleeding. […] Hysterectomy indicated if premalignant or malignant lesions are identified during workup of AUB.

• #54 Postmenopausal Bleeding: Causes and Treatments

  https://www.webmd.com/menopause/postmenopausal-bleeding

  How Is It Treated? […] That depends on whats causing the bleeding. […] Estrogen therapy: This hormone is used to treat vaginal and endometrial atrophy. Your doctor may prescribe it in one of the following forms: […] Progestin therapy: This lab-made version of progesterone is used to treat endometrial hyperplasia. Your doctor may prescribe it in a pill or shot, a vaginal cream, or intrauterine device. […] Hysteroscopy: This procedure can remove polyps. Doctors also use it to remove thickened parts of the uterine lining caused by endometrial hyperplasia. […] DC (dilation and curettage): In this surgery, the doctor opens your cervix. (You may hear them say they are going to dilate it). They use a thin tool to remove polyps or thickened areas of the uterine lining caused by endometrial hyperplasia.

• #55 Postmenopausal Bleeding: Causes and Treatments

  https://www.webmd.com/menopause/postmenopausal-bleeding

  How Is It Treated? […] That depends on whats causing the bleeding. […] Estrogen therapy: This hormone is used to treat vaginal and endometrial atrophy. Your doctor may prescribe it in one of the following forms: […] Progestin therapy: This lab-made version of progesterone is used to treat endometrial hyperplasia. Your doctor may prescribe it in a pill or shot, a vaginal cream, or intrauterine device. […] Hysteroscopy: This procedure can remove polyps. Doctors also use it to remove thickened parts of the uterine lining caused by endometrial hyperplasia. […] DC (dilation and curettage): In this surgery, the doctor opens your cervix. (You may hear them say they are going to dilate it). They use a thin tool to remove polyps or thickened areas of the uterine lining caused by endometrial hyperplasia.

• #56 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/

  Offer all women a 52 mg LNG-IUD; this preparation reduces episodes of unscheduled bleeding when compared to all other preparations. […] Oral preparations provide higher rates of amenorrhoea when compared to transdermal preparations and could be offered, if there are no risk factors for thrombosis, as a) a first-line therapy or b) to women who have recurrent unscheduled bleeding with transdermal preparations. […] Offer vaginal estrogens if there are atrophic findings on examination.

• #57 Abnormal Uterine Bleeding: Postmenopausal and Menopausal Transition | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688239/all/Abnormal_Uterine_Bleeding:_Postmenopausal_and_Menopausal_Transition

  For patients in MT, not indicated in postmenopausal (see surgical options): bleeding at this time is likely anovulatory due to paucity of progesterone in the second half of the cycle, leading to unopposed estrogen; raises the concern for endometrial hyperplasia, which must be ruled out prior to hormonal therapy. […] Goal of therapy is to stabilize the endometrium with progesterone. This can also help regulate the cycle and minimize other associated menopausal symptoms if present. […] No real consensus in the literature on best therapy out of choices listed below or length of therapy (6 to 12 months prior to discontinuing is reasonable). […] Progestin-only oral therapy (for symptom control only, no contraceptive coverage): Medroxyprogesterone acetate 10 mg PO daily for 14 days each month, Megestrol acetate 40 mg PO daily, Norethindrone acetate 2.5 to 10.0 mg PO daily times 5 to 10 days each cycle.

• #58 Abnormal (Dysfunctional) Uterine Bleeding Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/257007-treatment

  Medical treatment for women aged 40 years or older can, prior to menopause, consist of cyclic progestin therapy, low-dose oral contraceptive pills, the levonorgestrel intrauterine device, or cyclic hormone therapy. […] If medical therapy fails, patients should undergo further testing (eg, imaging or hysteroscopy). […] An in-office endometrial biopsy is preferable to dilation and curettage (DC) when initially examining a patient for endometrial hyperplasia or cancer. […] If medical therapy fails in a woman in whom childbearing is complete, hysterectomy may be considered. […] Oral contraceptive pills (OCPs) suppress endometrial development, reestablish predictable bleeding patterns, decrease menstrual flow, and lower the risk of iron deficiency anemia. […] OCPs can be used effectively in a cyclic or continuous regimen to control abnormal bleeding.

• #59 Abnormal Uterine Bleeding: Postmenopausal and Menopausal Transition | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688239/all/Abnormal_Uterine_Bleeding:_Postmenopausal_and_Menopausal_Transition

  For patients in MT, not indicated in postmenopausal (see surgical options): bleeding at this time is likely anovulatory due to paucity of progesterone in the second half of the cycle, leading to unopposed estrogen; raises the concern for endometrial hyperplasia, which must be ruled out prior to hormonal therapy. […] Goal of therapy is to stabilize the endometrium with progesterone. This can also help regulate the cycle and minimize other associated menopausal symptoms if present. […] No real consensus in the literature on best therapy out of choices listed below or length of therapy (6 to 12 months prior to discontinuing is reasonable). […] Progestin-only oral therapy (for symptom control only, no contraceptive coverage): Medroxyprogesterone acetate 10 mg PO daily for 14 days each month, Megestrol acetate 40 mg PO daily, Norethindrone acetate 2.5 to 10.0 mg PO daily times 5 to 10 days each cycle.

• #60 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/

  In women using sequential HRT (sHRT), offer a minimum of 10 days norethisterone (NET) or medroxyprogesterone acetate (MPA), or 12 days of micronised progesterone, per month. […] Women taking a sequential preparation (sHRT) over the age of 45 should be offered, after five years of use or by age 54 (whichever comes first), a change to continuous combined (ccHRT). […] 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. […] If unscheduled bleeding continues in low-risk women, after six months of adjustments, discuss the options of an urgent ultrasound (within six weeks) versus weaning off HRT and consideration of non-hormonal alternatives (to avoid invasive investigations).

• #61 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/

  Offer all women a 52 mg LNG-IUD; this preparation reduces episodes of unscheduled bleeding when compared to all other preparations. […] Oral preparations provide higher rates of amenorrhoea when compared to transdermal preparations and could be offered, if there are no risk factors for thrombosis, as a) a first-line therapy or b) to women who have recurrent unscheduled bleeding with transdermal preparations. […] Offer vaginal estrogens if there are atrophic findings on examination.

• #62 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

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

  Typically, leiomyomas (ie, fibroids) are benign and regress during menopause and may not need treatment if patients are asymptomatic. A small percentage of fibroids are malignant, primarily in postmenopausal women. Occasionally, benign leiomyomas may grow or become symptomatic even in postmenopausal patients, particularly in obese women, due to peripheral conversion of estrogen from adipose stores. In women with PMB found to have uterine fibroids with an otherwise normal evaluation, pharmacologic (eg, aromatase inhibitors and selective estrogen receptor modulators) or surgical (eg, myomectomy and hysterectomy) therapy may be considered. […] For sexually transmitted diseases and other genital infections, treatment is guided by vaginal culture results. Clinicians may consider oral doxycycline to treat endometritis.

• #63 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

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

  Typically, leiomyomas (ie, fibroids) are benign and regress during menopause and may not need treatment if patients are asymptomatic. A small percentage of fibroids are malignant, primarily in postmenopausal women. Occasionally, benign leiomyomas may grow or become symptomatic even in postmenopausal patients, particularly in obese women, due to peripheral conversion of estrogen from adipose stores. In women with PMB found to have uterine fibroids with an otherwise normal evaluation, pharmacologic (eg, aromatase inhibitors and selective estrogen receptor modulators) or surgical (eg, myomectomy and hysterectomy) therapy may be considered. […] For sexually transmitted diseases and other genital infections, treatment is guided by vaginal culture results. Clinicians may consider oral doxycycline to treat endometritis.

• #64 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

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

  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. […] 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. Oral hormone replacement and hormonal receptor modulators (eg, ospemifene) also may be considered if there is no improvement with other treatments. […] Thirty percent of PMB cases are caused by endometrial polyps; however, polyps can be asymptomatic. Furthermore, the severity of PMB is not affected by the number or size of polyps. One percent of all endometrial polyps are malignant, most commonly occurring in postmenopausal women. Therefore, endometrial polyps in symptomatic postmenopausal women should be removed and histologically assessed. Surgical excision should be considered in asymptomatic women at higher risk of malignancy (eg, large polyps, tamoxifen use, obesity, or diabetes). Hysteroscopic polypectomy is the preferred treatment because the clinician can obtain directed biopsies and excise polyps at once.

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

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

  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. […] 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. Oral hormone replacement and hormonal receptor modulators (eg, ospemifene) also may be considered if there is no improvement with other treatments. […] Thirty percent of PMB cases are caused by endometrial polyps; however, polyps can be asymptomatic. Furthermore, the severity of PMB is not affected by the number or size of polyps. One percent of all endometrial polyps are malignant, most commonly occurring in postmenopausal women. Therefore, endometrial polyps in symptomatic postmenopausal women should be removed and histologically assessed. Surgical excision should be considered in asymptomatic women at higher risk of malignancy (eg, large polyps, tamoxifen use, obesity, or diabetes). Hysteroscopic polypectomy is the preferred treatment because the clinician can obtain directed biopsies and excise polyps at once.

• #66 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. […] A monthly progestogen dose, in proportion to the estrogen dose, is recommended in women with a uterus.

• #67 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/

  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. If the bleeding has settled at a 4-week follow-up and there is a preference to restart HRT, offer adjustments in HRT for six months and then an urgent ultrasound if bleeding is heavy / persistent during the 6 months or, is continuing after this interval. […] 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. […] Offer an urgent suspicion of cancer pathway (USCP) referral to women with one major or three minor risk factors for endometrial cancer – irrespective of bleeding type or interval since starting or changing HRT preparations. Adjustments to the progestogen, or stopping HRT, should be offered whilst awaiting assessment.

• #68 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/

  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. If the bleeding has settled at a 4-week follow-up and there is a preference to restart HRT, offer adjustments in HRT for six months and then an urgent ultrasound if bleeding is heavy / persistent during the 6 months or, is continuing after this interval. […] 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. […] Offer an urgent suspicion of cancer pathway (USCP) referral to women with one major or three minor risk factors for endometrial cancer – irrespective of bleeding type or interval since starting or changing HRT preparations. Adjustments to the progestogen, or stopping HRT, should be offered whilst awaiting assessment.

• #69 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. […] 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). […] 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.

• #70 Perimenopausal Bleeding and Bleeding After Menopause | ACOG

  https://www.acog.org/womens-health/faqs/perimenopausal-bleeding-and-bleeding-after-menopause

  What treatment is available for abnormal bleeding? Treatment for abnormal bleeding during perimenopause or after menopause depends on the cause (see below). […] What if abnormal bleeding is caused by cancer? Endometrial cancer usually is treated with surgery. During surgery, the cervix and uterus are removed (hysterectomy), as well as both ovaries and fallopian tubes. Lymph nodes and other tissue may be removed and tested to see if the cancer has spread. […] What happens after surgery for endometrial cancer? After surgery, the stage of disease is determined. Staging helps determine if additional treatment, such as chemotherapy or radiation therapy, is needed. Stages of cancer range from I to IV. Stage IV is the most advanced. The stage of cancer affects the treatment and outcome. […] How are benign causes of abnormal bleeding treated? Polyps may be removed with a surgical procedure. Endometrial atrophy can be treated with medications. Endometrial hyperplasia can be treated with progestin therapy, which causes the endometrium to shed. Since women with hyperplasia are at increased risk of endometrial cancer, they need regular biopsies to make sure that the hyperplasia has been treated and does not return. Endometrial hyperplasia also can be treated with a DC procedure.

• #71 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. […] 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. […] When postmenopausal bleeding is diagnosed as endometrial cancer, most cases can be cured with a hysterectomy. However, because endometrial cancer can spread into the lymph nodes, many patients also should have a lymph node dissection at the time of hysterectomy.

• #72 Postmenopausal Vaginal Bleeding

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

  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 bleeding requires aggressive investigation to rule out malignancy. 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. Vaginal bleeding in women who do not have cancer and are not taking estrogen is often treated initially with estrogen to rule out bleeding secondary to genital atrophy. Local or systemic estrogen therapy provides symptom relief from significant vaginal dryness secondary to vaginal atrophy for most women. Topical estrogen in of vaginal cream form (1 to 3 times per week for maintenance), vaginal tablet (twice weekly for maintenance), or estrogen-infused vaginal ring (remaining in place for 90 days) dosage forms is used to treat vaginal dryness and dyspareunia. For vaginal bleeding in women already receiving HRT, dosage adjustment may be necessary: the estrogen dose may need to be decreased or the progesterone dose increased. Patients receiving HRT should be re-evaluated over time for continued appropriateness of therapy. Estrogens should not be considered first-line agents for the prevention of osteoporosis due to increased risk of breast cancer, heart disease, stroke, and deep-vein thrombosis. Alternatives to HRT (e.g., bisphosphonates [alendronate, ibandronate, risedronate]; the selective estrogen receptor modulator, raloxifene) should be considered, if appropriate, for osteoporosis prevention.

• #73 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 most cases, postmenopausal bleeding is due to benign (noncancerous) conditions and isnt a cause for worry. […] Talk to your healthcare provider if you experience any bleeding after menopause. […] Contact your healthcare provider if you experience bleeding after menopause as it could be a sign of a medical condition. […] Treatment for postmenopausal bleeding depends on its cause. Medication and surgery are the most common treatments. […] Medications include: Antibiotics treat most infections. Estrogen: Taking supplemental estrogen helps bleeding due to vaginal atrophy. […] Progestin treats endometrial hyperplasia by triggering your uterus to shed its lining. […] Surgical treatment includes: Hysteroscopy: This procedure allows providers to diagnose and treat causes of uterine bleeding like polyps or growths.

• #74 Postmenopausal Bleeding > Fact Sheets > Yale Medicine

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

  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. […] Vaginal atrophy: Doctors may prescribe vaginal lubricants, topical hormones, or other medications to reduce vaginal dryness. […] Polyps or fibroids. If polyps or fibroids are the source of postmenopausal bleeding, surgery may be recommended to remove them. […] Hormone therapy. If the bleeding occurs because of hormone therapy, doctors may modify or suspend therapy. […] Infection. If an infection is identified, medications will be prescribed to eliminate the infection and stop future bleeding. […] Thick uterine lining. If postmenopausal bleeding happens because a woman has a thick uterine lining (endometrial hyperplasia), progestin therapy may be prescribed to trigger shedding of the uterine lining. Sometimes, doctors may remove the uterine lining surgically, during a dilation and curettage (DC) procedure.

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