Postmenopausal Vaginal Bleeding

Introduction

• Description: As a symptom only, postmenopausal bleeding—vaginal bleeding that occurs in women who have passed menopause—requires evaluation to rule out processes that may threaten the long-term health of the patient.

• Prevalence: Common, up to 10% of postmenopausal women.

• Predominant Age: 50 years or older. Most common near the age of menopause; declines thereafter.

• Genetics: No genetic pattern.

Etiology and Pathogenesis

• Causes: Systemic—estrogen, estrogen/progesterone, thrombocytopenia. Uterine—endometrial polyp (most common, 35%–40%), endometrial atrophy (second most common, 30%), endometrial cancer (approximately 6%–10%), endometrial hyperplasia, endometritis, submucous leiomyomata. Cervical sources—carcinoma, cervical eversion, cervicitis, condyloma, polyps. Vaginal sources—adenosis, atrophic change, carcinoma, foreign bodies (condom, pessary, tampon), infection, lacerations (coital injury, trauma). Vulvar and extragenital sources—atrophy, condyloma, cystitis/urethritis, gastrointestinal (cancer, diverticulitis, inflammatory bowel disease), hematuria, hemorrhoids, infection, labial varices, neoplasm, trauma, urethral caruncle, urethral diverticula, urethral prolapse/eversion.

• Risk Factors: Estrogen therapy, others based on specific pathologic conditions.

Signs and Symptoms

• Painless vaginal bleeding (spontaneous or iatrogenic)

• Pink or dark discharge noted on the underwear or when wiping after urination

Diagnostic Approach