Postmenopausal Bleeding : Know The Causes, Symptoms and Treatment - Diseases Treatment - Symptoms, Causes and Cure for Diseases on A to Z

What is this condition?

Postmenopausal bleeding is defined as bleeding from the reproductive tract that occurs 1 year or more after menstrual periods stop. Sites of bleeding include the vulva, vagina, cervix, and endometrium. Prognosis varies with the cause.

What causes it?

Postmenopausal bleeding may result from:

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estrogen therapy - when excessive amounts are given or when small amounts are given in the presence of a hypersensitive endometrium.

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internal estrogen production - especially when levels are high, as in persons with estrogen-producing ovarian tumors; however, in some persons, even slight fluctuation in estrogen levels may cause bleeding.

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atrophic endometrium - due to low estrogen levels.

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atrophic vaginitis - usually triggered by trauma during intercourse when estrogen is lacking.

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aging- which weakens blood vessels, produces degenerative tissue changes, and decreases resistance to infections.

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adenomatous hyperplasia or atypical adenomatous hyperplasia­ usually considered a premalignant lesion.

What are its symptoms?

Vaginal bleeding, the predominant symptom, ranges from spotting to outright hemorrhage; its duration also varies. Other symptoms depend on the cause. Excessive estrogen stimulation, for example, may also produce copious cervical mucus; estrogen deficiency may cause the vaginal mucosa to shrink.

How is it diagnosed?

The doctor will perform a physical exam (including a pelvic exam), obtain a detailed history, and order standard lab tests (such as complete blood count) and a cytologic exam of tissue specimens from the cervix and the endocervical canal. An endometrial biopsy or dilation and curettage reveals evidence of disease in the endometrium.

Diagnosis must rule out any underlying disease. For instance, evidence of elevated levels of endogenous estrogen may suggest an ovarian tumor. Before testing for estrogen levels, the woman must stop all sources of estrogen intake - including face and body creams that contain estrogen - to rule out excessive estrogen as a cause.

How is it treated?

Emergency treatment to control massive bleeding is rarely necessary, except in advanced cancer. Treatment may include dilation and curettage to relieve bleeding. Other therapy varies according to the underlying cause. Estrogen creams and suppositories are usually effective in correcting estrogen deficiency because they're rapidly absorbed. Hysterectomy is indicated for repeated episodes of postmenopausal bleeding from the endometrial cavity. Such bleeding may indicate endometrial cancer.

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