POSTMENOPAUSAL BLEEDING (PMB)
PMB refers to any bleeding from the genital tract in a menopausal woman (other than the expected bleeding that occurs in women taking cyclical HRT).
POSTMENOPAUSAL BLEEDING (PMB) OVERVIEW
PMB refers to any bleeding from the genital tract in a menopausal woman (other than the expected cyclical bleeding that occurs in women taking cyclical postmenopausal hormone replacement therapy).
Abnormal bleeding noted in the genital area is usually attributed to an intrauterine source, but may actually arise from the cervix, vagina, vulva, or fallopian tubes, or be related to ovarian pathology. The origin of bleeding can also involve non-gynaecological sites, such as the urethra, bladder, anus/rectum/bowel, or perineum.
Some of the causes of abnormal bleeding during menopause include:
- Atrophy or excessive thinning of the tissue lining the vagina and uterus, caused by low hormone levels
- Abnormalities of the cervix (neck of the womb)
- Cancer or precancerous changes (hyperplasia) of the uterine lining (endometrium)
- Polyps of the lining or neck of the womb
- Infection of the uterus
- Use of blood thinners or anticoagulants
- Side effects of radiation therapy
All postmenopausal women with unexpected uterine bleeding should be evaluated for endometrial cancer since this potentially lethal disease will be the cause of bleeding in approximately 10% of cases of PMB. However, it is important to note that the most common cause of abnormal bleeding in postmenopausal women is atrophy of the vaginal mucosa or endometrium, not cancer.
EVAULATION OF WOMEN WITH PMB
Owing to the concern of a possible underlying diagnosis of cancer, women should not delay seeing their general practitioners or a specialist gynaecologist.
Evaluation will include all of some of the following:
- A full history and clinical examination (including a vaginal assessment)
- Pelvic ultrasound scan to assess the lining of the uterus (endometrium) and look for other potential causes of PMB.
- Biopsy of the endometrium – often performed in the outpatient setting
- Cervical (pap) smear
- Hysteroscopy (telescope that is inserted into the uterus via the vagina and cervix)