What is Postmenopausal Bleeding?

• Any amount of bleeding from the vagina after a woman has stopped having menstrual cycles for 12 months (menopause) is termed as postmenopausal bleeding
• Spotting or light bleeding after menopause might not seem like a serious problem, but one should never ignore it
• Any bleeding should trigger a visit to your doctor as soon as possible

Causes for Postmenopausal Bleeding?

• Vaginal atrophy / Endometrial atrophy (most common)
• Cervical polyps / Uterine polyps
• Endometrial hyperplasia
• Endometrial cancer (10% cases)
• Medications like Tamoxifen (used in Breast cancer)
• Hormone replacement therapy (cyclical / breakthrough)

How to evaluate women with Postmenopausal Bleeding?

• A gynaecology consultation should be arranged for every woman with postmenopausal bleeding. Detailed history, speculum examination, drug history, family history (any cancers) should be enquired
• Transvaginal Ultrasound for better visualisation of pelvic pathology
• Office Hysteroscopy – a thin flexible scope to examine the endometrial cavity and its lining (OPD procedure)
• Hysteroscopic guided biopsy / Fractional Curettage – samples from endometrial tissue tested for the presence of any cancerous cells

What are the treatment options?

It depends on the cause for the bleeding

• Oestrogen therapy: To treat vaginal and endometrial atrophy. Can be prescribed in various forms – oral pills, vaginal cream, vaginal tablet or vaginal ring
• Progestin therapy: Ideal for endometrial hyperplasia
  (simple). Can be used as oral pills or an intrauterine device
• Hysteroscopy: For the removal of polyp (polypectomy)
• Hysterectomy: In precancerous form of endometrial hyperplasia and early stages of uterine and cervical cancer, total hysterectomy can be performed (sometimes requires lymph nodes removal also)
• For late-stage cancers, radiotherapy and chemotherapy can be offered

Dr Sameetha Pallem
MBBS, MS (OBG)
Consultant Obstetrician & Gynaecologist
Giggles by OMNI RK, Visakhapatnam