At menopause, women stop experiencing menstruation for 12 months and down to the grave. However, there are women who take cyclic postmenopausal hormone therapy which causes cyclic bleeding, these are not the focus.
PMB is a condition where a woman experiences uterine bleeding after menopause, this is abnormal and so is spotting after menopause.
PMB is a symptom of endometrial carcinoma, however it could be caused by atrophy of the vaginal mucosa or endometrium.
It occurs in about 11% of postmenopausal women.
Source of Bleeding
While abnormal bleeding in the genital area is attributable to an intrauterine source, it may draw from the vulva, vagina, cervix or fallopian tubes. It may also originate from nongynecologic areas like the urethra, anus, bowel, rectum, bladder or the perineum.
There are diverse causes, including:
Leiomyomas (Fibroids) – They cause both premenopausal and postmenopausal bleeding.
Atrophy – This is the thinning of the endometrium (uterine lining). Loss of moisture in the uterine cavity can cause cracks and eventual bleeding. Usually minimal and occurs ten years into menopause.
Endometrial Polyps – May develop due to obesity, hormone replacement therapy or using tamoxifen. They may be cancerous and are usually remove when noticed. Removal could get to the uterine muscle and upon regrowth, the polyps would cause bleeding.
Endometrial Hyperplasia – The over-thickening of the uterine lining which may lead to endometrial cancer or uterine cancer. It causes PMB in 5% of women.
Other causes include:
- Hormone Replacement Therapy (Menopause Hormonal Therapy)
- Cervical Polyps
- Herbal Supplements
- Cervical Cancer
- Bleeding disorders
- Anticoagulant Use
- Lesions of the cervix
- Medication, like blood thinners.
In carrying out a diagnosis of Postmenopausal Bleeding (PMB), the doctor would look into the history of the patient to check for risk factors and other possible causes.
The doctor would proceed to carry out pelvic examinations to ascertain the cause of the bleeding. If this yields no result or clues, tests will be ordered.
The tests include a transvaginal pelvic ultrasound, smear test (of the uttering lining), Hysteroscopy, Pipelle biopsy, Dilatation and curettage (D & C), etc.
This depends largely on the results of the test and the eventual diagnosis as well as the underlying cause of the Postmenopausal Bleeding (PMB).
Cervical Polyps – This usually requires surgery for removal.
Atrophic Vaginitis – Treated using an estrogen cream for a number of weeks as prescribed by the doctor. Another option is Menopause Hormonal Therapy (MHT). However, this treatment comes with a lot of risks and should be thought through carefully.
Simple Endometrial Hyperplasia – Further treatment like progestogen therapy will be administered by professional GP to treat this condition especially if it is in its early stages. Otherwise, the patient would be guided on how to manage the condition.
Complex Endometrial Hyperplasia – Treating this may require a hysterectomy.
Endometrial Cancer – Surgery could solve this especially in the early stages. It would require hysterectomy and removal of the cervix, ovaries and fallopian tubes. In its advanced stages, radiation, hormone therapy and chemotherapy become expedient in managing the condition.
Progressive Women’s Health is not just a diagnostic center, treatment, care and management are provided for clients suffering this condition.