Post-Menopausal Bleeding

Menopause is defined as 12 consecutive months without a period. Any bleeding, even a drop of pink blood that you think maybe occurred because you scratched the area, needs to be evaluated. This is post-menopausal bleeding (PMB) and concerning reasons for it need to be excluded before saying it was just a scratch.

Not all PMB means something terrible is happening. There are many possible causes that are benign. It can be a scratch, but that should be limited not recurrent. It can be a urinary tract infection (frequent ruination, painful urination, blood on wiping or in toilet bowl). It can be from polyps in the uterus, overwhelmingly benign. These occur with more frequency in women taking tamoxifen for breast cancer recurrence often e prevention. And it can be from hyperplasia, an overgrowth of tissue in the lining of the uterus. Depending on the kind of hyperplasia, the risk of there being a cancer or becoming a cancer varies. Fibroids are also a common cause of abnormal bleeding, but should shrink in menopause and not bleed.

Evaluations should include a good history and physical exam. An ultrasound to look at the thickness of the lining of the uterus (less than 4mm is reassuring in a post menopausal woman not taking hormones), as well as for the presence of fibroids or polyps. A uterine biopsy may also be performed as well as a urinalysis. There is the option of an office hysteroscopy too. A small camera attached to a straw like instrument is inserted directly into the uterus which can visualize the cavity and a biopsy can be taken through a port. This is an office procedure not requiring a aesthetic.

Depending on the results, next steps will be discussed with your physician.

Do not ignore PMB.