II. Causes

  1. See Abnormal Uterine Bleeding Causes
  2. Extra-uterine source
    1. Cervical, vaginal, vulvar and Adnexal bleeding
    2. Hematuria (Urethra, Bladder, ureter or Kidney)
    3. Lower Gastrointestinal Bleeding (e.g. rectal bleeding)
  3. Evaluate for Malignancy!
    1. Postmenopausal Bleeding is due to malignancy (esp Endometrial Cancer) in up to 40% of cases
    2. Peak Incidence of Endometrial Cancer is age 60-64 years
  4. Atrophic Vaginitis
    1. Most common cause of Postmenopausal Bleeding
  5. Postmenopausal Endometrial Hyperplasia
    1. If no Estrogen Replacement, find Estrogen source

III. Indications: Evaluation for Postmenopausal Bleeding

  1. Postmenopause without Hormone Replacement
  2. Postmenopause on Hormone Replacement >6 months

IV. Evaluation

  1. See Endometrial Cancer Screening
  2. Careful exam of external genitalia as well as speculum exam
  3. Catheterized Urinalysis
  4. Rectal exam

V. Imaging

  1. Transvaginal Ultrasound
    1. Determine endometrial thickness (5 mm)
    2. Evaluate for other uterine and Adnexal anomalies

VI. Management

VII. References

  1. Apgar (2003) AAFP Board Review, Seattle

Images: Related links to external sites (from Google)

Ontology: Postmenopausal bleeding (C0032776)

Concepts Pathologic Function (T046)
ICD9 627.1
ICD10 N95.0
SnomedCT 156052000, 76742009
English POST-MENOPAUSAL BLEEDING, postmenopausal bleeding (diagnosis), postmenopausal bleeding, postmenopausal bleeding (symptom), Post-menopausal bleeding, Hemorrhage postmenopausal, Postmenopausal hemorrhage, Bleeding;postmenopausal, after bleeding menopause, bleeding after menopause, bleeding post-menopausal, bleeding postmenopausal, post-menopausal bleeding, after menopause bleeding, Haemorrhage postmenopausal, Postmenopausal haemorrhage, Postmenopausal bleeding, Bleeding after menopause, PMB - Postmenopausal bleeding, Postmenopausal bleeding (finding), blood loss; postmenopausal, hemorrhage; postclimacteric, hemorrhage; postmenopausal, postclimacteric; hemorrhage, postmenopausal; blood loss, postmenopausal; hemorrhage, Postmenopausal Hemorrhage
Italian Emorragia post-menopausale, Emorragia postmenopausale, Sanguinamento post-menopausale, Sanguinamento postmenopausale
Dutch hemorragie postmenopauzaal, postmenopauzale bloeding, Postmenopauzaal bloedverlies, bloeding; postclimacterieel, bloeding; postmenopauzaal, bloedverlies; postmenopauzaal, postclimacterieel; bloeding, postmenopauzaal; bloeding, postmenopauzaal; bloedverlies, postmenopauzale hemorragie
French Saignement postménopausique, Hémorragie postménopausique, Saignement post-ménopausique, HEMORRAGIE POST-MENOPAUSIQUE, Hémorragie post-ménopausique
German Blutung postmenopausal, POSTMENOPAUSALE BLUTUNG, Postmenopausenblutung, postmenopausale Blutung
Portuguese Hemorragia pós-menopáusica, HEMORRAGIA POST-MENOPAUSA, Hemorragia pós-menopausa
Spanish Sangrado postmenopáusico, SANGRADO POSTMENOPAUSICO, metrorragia de la postmenopausia, metrorragia posmenopáusica, metrorragia postmenopáusica (hallazgo), metrorragia postmenopáusica, sangrado posmenopáusico, sangrado postmenopáusico, Hemorragia postmenopáusica
Japanese 閉経後出血, ヘイケイゴシュッケツ
Czech Post-menopauzální krvácení, Postmenopauzální krvácení
Korean 폐경기후 출혈
Hungarian Postmenopausalis vérzés, postmenopausalis vérzés, Postmenopausalis haemorrhagia, menopausa utáni vérzés