It is the bleeding from the female genital tract that occurs six or more months after menopause (that is, after the last menstrual period). In the majority of cases, a simple cause is eventually identified. However, in some cases, this bleeding may originate from a serious underlying condition. If you experience bleeding after menopause, you should visit your doctor as soon as possible.
The causes of postmenopausal bleeding are numerous. The most common is vaginal dryness due to estrogen deficiency. The vaginal mucosa (the tissue lining the inner wall) becomes very dry and thin, and friction between the dry surfaces of the vagina may cause bleeding. Women who are receiving hormone replacement therapy (HRT) without a continued menstrual cycle may also experience episodes of bleeding. Bleeding may also originate from ulcers, fissures, or lesions of the vulva. Vaginal lesions, cervical polyps, cervical cancer, endometrial polyps (of the tissue lining the inside of the uterus), excessive thickening of the endometrium (endometrial hyperplasia), endometrial cancer, uterine fibroids, ovarian cancer, and estrogen-producing tumors that develop in other organs, such as the ovaries, may also present with bleeding.
Diagnosis will be based on the medical history and physical examination, which includes a thorough inspection of the vulva, vagina, and cervix using a speculum and a special optical instrument, as well as a general examination for other pathological conditions. The doctor may request a transvaginal ultrasound to measure the thickness of the endometrium. When the endometrial thickness is less than 5 mm, the risk of endometrial cancer is below 1%.
Other tests that may be required include hysteroscopy and biopsy. Hysteroscopy involves inserting a small endoscope into the uterine cavity to obtain a small sample of endometrial tissue for further microscopic (histological) examination. This procedure is often performed on an outpatient basis (hospital admission is not required). During this examination, polyps and small fibroids can also be detected and removed.
When the diagnosis is cancer, some type of surgical intervention is required.
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