(Bleeding, Postmenopausal; PMB)
Postmenopausal bleeding (PMB) is bleeding from the vagina that happens after a woman has stopped having regular menstrual periods because of
. Any vaginal bleeding that occurs 12 months after a woman’s last menstrual period is considered PMB.
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PMB may be caused by several factors. These may include:
Continuous hormone replacement therapy (HRT)
- Thinning and loss of elasticity of the vagina
- Inflammation of the endometrium, the lining of the uterus
- Endometrial hyperplasia, a thickening of endometrium
- Polyps, noncancerous growths on the uterus or cervix
- Infection of the uterus or cervix
- Endometrial cancer
in the uterus or vagina
Some medical conditions and medications you take can increase your chances of having PMB.
Vaginal bleeding is a symptom of PMB. Your doctor can determine what condition is causing the bleeding and whether it is serious. If you have PMB, you should see your doctor.
You will be asked about your symptoms and medical history. A physical exam will be done.
Tests will be done to find the cause of the bleeding. Tests include:
Your doctor may need cell and tissue samples. This can be done with:
- Cervical cancer screening
- Endometrial biopsy
Talk with your doctor about the best treatment plan for you. The first priority is ruling out cancer. Treatment will depend on the findings of your tests and the cause of the bleeding. For instance, if your tests show signs of cancer, you will be referred to an oncologist, a doctor who specializes in treating cancer.
There are no current guidelines to prevent PMB.
American Congress of Obstetricians and Gynecologists
Office on Women's Health
The Society of Obstetricians and Gynaecologists of Canada
American Congress of Obstetricians and Gynecologists (ACOG) Committee Opinion on role of transvaginal ultrasonography in evaluation of postmenopausal bleeding.
Obstet Gynecol. 2009;113(2):462.
Gale A, Dey P. Postmenopausal bleeding.
Menopause Int. 2009;15(4):160-164.
Perimenopausal bleeding and bleeding after menopause. American Congress of Obstetricians and Gynecologists website. Available at:
http://www.acog.org/~/media/For%20Patients/faq162.pdf?dmc=1&ts=20121221T1430328285. Updated May 2011. Accessed March 14, 2016.
Postmenopausal bleeding. EBSCO DynaMed Plus website. Available at:
http://www.dynamed.com/topics/dmp~AN~T116214/Postmenopausal-bleeding. Updated June 19, 2014. Accessed March 14, 2016.
Sonohysterography. Radiological Society of North America Radiology Info website. Available at:
http://www.radiologyinfo.org/en/info.cfm?pg=hysterosono. Updated August 7, 2014. Accessed March 14, 2016.
11/5/2014 DynaMed's Systematic Literature Surveillance
http://www.dynamed.com/topics/dmp~AN~T116214/Postmenopausal-bleeding: Khati NJ, Glanc P, et al. ACR Appropriateness Criteria abnormal vaginal bleeding [online publication]. Reston (VA: American College of Radiology (ACR); 2014. 13 p. Available at: https://acsearch.acr.org/docs/69458/Narrative. Accessed March 14, 2016.
- Reviewer: EBSCO Medical Review Board
Marcie L. Sidman, MD
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