Post-menopausal Bleeding (PMB)

Bleeding after menopause, also known as post-menopausal bleeding (PMB), is a condition characterized by vaginal bleeding after 12 months of menopause. PMB is not pertinent to young women having amenorrhoea (absence of menstrual periods) due to anorexia nervosa or having a pregnancy followed by lactation. PMB may be related to those young women who are suffering from premature ovarian failure or premature menopause.

Menopause is a natural biological process resulting in a permanent cessation of menstruation. Menopause usually occurs in women during the fifth decade of their life. Menopause is confirmed by an absence of menstrual periods for 12 months consecutively.

In most cases, PMB is harmless, but sometimes it may be secondary to an underlying medical disorder. Therefore bleeding after menopause should be carefully investigated.

Causes

The common causes of post-menopausal bleeding include:

• Thinning of the tissues lining the uterus (endometrial atrophy) or vagina (vaginal atrophy)
• Uterine fibroids
• Cervical and endometrial polyps
• Infection and inflammation of the uterine lining (endometritis)
• Endometrial hyperplasia
• Medications such as hormone replacement therapy
• Cancer of the uterus, including endometrial cancer and uterine sarcoma
• Cancer of the cervix or vagina
• Non-gynaecological causes such as pelvic trauma or bleeding disorder
• Bleeding from the urinary tract or rectum

Determining the cause of postmenopausal bleeding

The cause of PMB can be determined by physical examination, medical history, and additional laboratory tests. The common tests that are employed are as follow:

• Transvaginal ultrasound: A specially designed imaging device is inserted through the vagina to view the pelvic organs and to identify any abnormalities.
• Endometrial biopsy: This procedure involves the insertion of a thin tube inside the uterus for withdrawing the samples of uterine lining, for laboratory analysis.
• Hysteroscopy: It involves the examination of the uterus through an instrument with a small camera and with a light source.
• D&C (dilation and curettage): This test involves the removal of tissues from the uterine lining to be sent for laboratory analysis.

Treatment

Treatment of the PMB depends on the underlying cause of bleeding. Management of some of the common causes of PMB is as follow:

• Polyps: They are surgically removed
• Endometrial atrophy: Treated with medications
• Endometrial hyperplasia: Treated with medications and/or thickened areas of the endometrium are surgically removed
• Endometrial cancer: Treatment involves total hysterectomy i.e. surgical removal of uterus and cervix. In some cases, other organs such as ovaries, fallopian tubes, nearby lymph nodes, and part of vagina may also be removed.

The treatment of advanced endometrial cancer may include hormone therapy, chemotherapy, and radiation therapy. Early detection and treatment of the cancer can result in full recovery.