Post Menopausal Bleeding

What is it

Post menopausal bleeding is defined as any vaginal bleeding occuring in a menopausal woman - that is once she has been twelve months without a menstrual period.

It includes all types of vaginal blood loss - even if there is nothing more than a small amount of blood stained discharge.

In medical texts it is written as postmenopausal bleeding, and is also known as PMB.

Why is it important

Post menopausal bleeding is not an uncommon complaint. In the vast majority of cases no serious cause is discovered - however, a minority of women will be diagnosed with an important medical problem requiring treatment.

Some women avoid reporting their symptoms, either because they think that bleeding after menopause is unimportant or because they are too frightened in case there is a serious cause. However, even if a cancer is diagnosed then early treatment will more likely result in a cure.

Medical advice is that any PMB should be reported to the doctor without delay.

What are the causes

Post menopausal bleeding can be caused by many things. The most common of the serious disorders is endometrial cancer [cancer of the lining of the uterus or womb].

However, in most women who have post menopausal bleeding cancer is not detected.

Less sinister causes include -

- vaginal atrophy [thinning and soreness of the vaginal wall]
- secondary to the use of hormone replacement therapy
- cervical polyps [small non-cancerous growths near the cervix]
- endometrial hyperplasia [non-cancerous thickening of the womb lining]
- generalized bleeding disorders
- bladder complaints [when urinary blood is mistaken for vaginal]
- unknown [no cause found]

On rare occasions other types of cancer are diagnosed.

What will my doctor do

Postmenopausal bleeding must be investigated. Your doctor will refer you to a gynaecologist.

Tests will usually include speculum examination [like when you have your cervical smear tests] and ultrasound. Sometimes a small biopsy of the womb lining is taken.

In the vast majority of cases no serious cause will be found.

Risks factors for cancer of the lining of the uterus

Women with postmenopasal bleeding are referred for tests to, hopefully, exclude endometrial cancer [cancer of the lining of the womb or uterus].

Certain women are at increased risk of developing this type of cancer. Oestrogen is stimulatory to the lining of the womb lining, and most of the risk factors are known to affect levels of oestrogen -

- tamoxifen treatment [medication used for breast cancer]
- oestrogen tablets [HRT - when used alone without progesterone]
- early onset of periods when combined with a late menopause
- obesity [body fat is a source of oestrogen particularly after the menopause]
- polycystic ovarian syndrome [PCOS]
- diabetes [even when not associated with being overweight]
- a history of infertility and no pregnancies
- age [risk increases with age]

Conversely there are some protective factors -

- use of the combined oral contraceptive pill, especially long-term use
- the intra-uterine device [IUD or the coil]
- many pregnancies

PLEASE NOTE - These are just risk factors and do not mean that you are destined to get cancer of the womb. Many women with risk factors never get the disease, and on the other hand some women are diagnosed even though they have none of these risk factors.

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