Bleeding from the uterus occurring at least 6 months after menstruation has stopped
Menstrual bleeding should cease at the menopause. Postmenopausal bleeding is normal only with certain forms of hormone replacement therapy that cause withdrawal bleeding, usually once a month. Other postmenopausal bleeding may be a sign of a serious disorder, such as cancer of the reproductive tract, and should be investigated urgently by a doctor. Postmenopausal bleeding may range from light spotting to a heavier flow of blood and is usually painless.
Postmenopausal bleeding can be a symptom of various disorders of the vulva, vagina, cervix, uterus, fallopian tubes, and ovaries. The most common and least serious cause of such bleeding is atrophic vaginitis, in which the vagina becomes thinned due to low levels of oestrogen after the menopause (see Vulvovaginitis).
Postmenopausal bleeding could be caused by a disorder of the cervix, such as cervical ectopy or cancer of the cervix. In these disorders, bleeding from the cervix may be more likely to occur after sexual intercourse. Postmenopausal bleeding may also be the result of a thickened endometrium (the lining of the uterus) or precancerous or cancerous growths in the uterus (see Cancer of the uterus). Cancer of the vulva and vagina may also lead to postmenopausal bleeding, although both of these disorders are very rare.
Your doctor will examine the vagina and cervix to look for abnormalities. If abnormal areas are seen in the vagina, a small sample of tissue may be taken for examination under a microscope. Your doctor may also perform a cervical smear test to check for abnormal cells in the cervix. In some cases, a sample of endometrial tissue may be taken for analysis (see Endometrial sampling).
The treatment for postmenopausal bleeding varies depending on the under-lying cause. Oestrogen creams that are applied to the vagina may be prescribed to relieve atrophic vaginitis. Surgery may be necessary to remove cancerous growths. Surgery may also be carried out to treat disorders of the cervix and uterus, such as a thickened endometrium. Postmenopausal bleeding should cease once the underlying disorder has been treated.
From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.