This document discusses postmenopausal bleeding, defined as any vaginal bleeding occurring more than 12 months after a woman's last menstrual period. The most common causes are atrophic vaginitis (60-80%), estrogen treatments (15-25%), and cervical or uterine polyps (2-12%). Evaluation involves obtaining a medical history, performing a clinical examination including a cervical smear and pelvic exam, and diagnostic testing such as ultrasound and endometrial biopsy. Treatment depends on the underlying cause, but may include hormone therapy for atrophic vaginitis or polyp removal, and in some cases of hyperplasia or cancer, hysterectomy.

1. POST MENOPAUSAL
BLEEDING
BY DR.HAFSA ASIM

2. DEFINITION
• Postmenopausal bleeding is any vaginal bleeding that occurs after 12
months of amenorrhea in a postmenopausal women.
• The age of menopause is variable, but for most women it is 51yrs

3. CAUSES
• Atrophic vaginitis 60-80%
• Estrogen treatments 15-25%
• Polyp cervical –uterine 2-12%
• Endometrial Hyperplasia 5-10%
• Enodometrial cancer 10%
• No cause found 10%

4. Atrophic Vaginitis
• It is the most common cause of postmenopausal uterine bleeding
• 25- 50% of women experience symptoms due to atophic vaginitis.

5. Cervical polyp
It is the second most common cause.

6. Hormone replacement therapy
• Any vaginal bleeding in a menopausal woman other than the
expected cyclical bleeding that occurs in women taking sequential
HRT should be managed.

7. idiopathic cause
• 10–15 %of patients, no evident cause for the
bleeding will be found.
• It is therefore necessary to look for blood in the
stool/urine, especially if the source of bleeding is
unclear.

8. Endometrial hyperplasia &Endometrial cancer
• reassure women that only 10 percent of those presenting with
postmenopausal bleeding will have endometrial cancer
• 90 per cent of women with endometrial cancer will present with
vaginal bleeding

9. Investigations
• History
• Clinical examination
• Cervical cytology
• Ultrasound scan
• Outpatient hysteroscopy
• Endometrial biopsy

10. History
• Duration and severity
• No evidence of association with pattern of bleeding and malignancy
eg: one off bleed vs regular bleeding
• Associated symptoms
• Hormonal treatment
• Past medical and surgical history
• Family History of colorectal, endometrial or other cancers associated
with hereditary non-polyposis colorectal cancer Lynch ll syndrome

11. • Clinical examination
•General: •obesity? •thyroid? pallor? •pulse? Cachexia?
• Abdominal and pelvic examination
• Speculum examination of the cervix
• Bimanual examination
• Cervical smear
• Colposcopy
• Ultrasound scan
• Transvaginal ultrasound •Thickened (>5mm( endometrial stripe in
postmenopause ALWAYS needs further evaluation.

12. Management
• General treatment:
• In some cases the blood loss may be excessive, rapid and possibly life
threatening. Correct general condition(Anti-shock-Hospitalization)
• Rapid restoration of blood volume ,vital parameters.

13. Treatment
• Treatment depends on what's causing your bleeding.
• Cervical polyps the polyps may need to be removed
• Endometrial atrophy offer oestrogen cream or pessaries
• Endometrial hyperplasia depending on the type of
hyperplasia, no treatment, hormone
medicine (tablets or an intrauterine system, IUS) or a total
hysterectomy (surgery to remove your uterus, cervix and ovaries)

14. THANK YOU