Common causes of post menopausal bleeding

Menopause is the permanent cessation of periods. Hence any bleeding after attainment of Menopause more than a year would be considered post menopausal bleeding . Any bleeding after attainment of menopause is unusual and maybe a sign of a health condition that requires attention. While most causes may not be serious it is important to see a doctor to rule out endometrial cancer which can be present 10-15% of cases.

Some common causes of Post Menopausal Bleeding are:

1. Endometrial Atrophy i.e. Thinning of Uterine lining
2. Vaginal Atrophy i.e. Thinning and Inflammation of Vaginal lining.
3. Endometrial Hyperplasia i.e Thickening of the Uterine lining which can be caused due to High Estrogen levels secondary to HRT or Obesity.
4. Uterine Polyps , Fibroids, Infections of the uterus or the cervix-Cervicitis, Endometritis.
5. Less commonly by cancers of the Endometrium , Cervix or Ovary.
6. Some Medications like Estrogen, Anti coagulants,etc.

Evaluation of Post Menopausal Bleeding will include
1. Pelvic examination
2. Papsmear
3. Transvaginal scan – Ultrasound
4. Saline Infusion Ultrasound
5. Hysteroscopy
6. Endometrial Biopsy/ Endometrial Aspiration

Treatment of Post Menopausal Bleeding is completely dependent on the cause.
Medications include :
1.Antibiotics or Antifungals for infection
2.Estrogen creams for Vaginal Atrophy
3.Progestrone tablets and Intrauterine devices for Endometrial Hyperplasia

Surgical Treatment includes:

1.Hysteroscopy:This procedure helps to diagnose and treat causes like Polyps and Growths.
2.Dilatation and Curettage- D&C: Is a procedure to remove the lining and contents of the uterus for diagnostic and therapeutic purposes.
3.Hysterectomy: This is a surgery to remove the uterus and maybe required if there is a suspicion of cancer.

Conclusion

Post Menopausal bleeding has a favourable Prognosis as the most common aetiologies are benign and treatable. The Prognosis for the malignant aetiologies like endometrial cancer is also better than other cancers with a 5 year survival rate of 90%.Patients should be educated that any bleeding after menopause is established, is considered abnormal and instructed when to seek medical attention. This will go a long way in ensuring better health for post menopausal women.

(Article Courtesy: Dr. Preeti Prabhakar Shetty, MBBS, MD - Obstetrics & Gynaecology, Senior Consultant Obstetrician,Gynecologist, Apollo Hospitals, Bannerghatta Road, Bangalore)