Menopause is defined as the cessation of vaginal bleeding/menses for 12 months therefore any bleeding after that 12 month period is considered postmenopausal bleeding (PMB) and warrants evaluation. 
This excludes cyclic bleeding from the use of sequential postmenopausal hormone replacement therapy which is an expected occurrence during this type of therapy. 

With the most common cause of postmenopausal bleeding being vaginal or endometrial atrophy, there is always a concern of the presence of endometrial cancer, as 10% of women with PMB have the disease. Other causes of vaginal bleeding in menopausal women include possible the late effect of past radiation therapy, use of certain herbal/dietary supplements, ovulation, adenomyosis, endometrial hyperplasia (thickening of the uterine lining), polyps, hormone therapy, infection blood thinners, fibroids and other gynecologic cancers such as fallopian tube, vaginal, vulvar and cervical cancers, as well as other non-gynecologic disease processes.

Evaluation and Diagnosis

During evaluation for PMB, you can expect that your healthcare provider will discuss your medical history and perform a physical examination, including obtaining a Pap smear which will also screen for cervical cancer as a cause of the vaginal bleeding. Other exams which may be recommended include the use of:

• Transvaginal Ultrasound: A transvaginal ultrasound is used so that the pelvic organs such as the ovaries, uterus and cervix can be viewed and evaluated.
• Endometrial Biopsy: A sample of the lining of the uterus is obtained by passing a thin tube into the uterus.
• Hysteroscopy: This exam entails a scope being inserted into the uterus for evaluation of the endometrial tissue at which time biopsies of the uterine lining will be taken for further evaluation.1 If polyps are present, these too may be removed.1
• Saline-infused sonogram: During this procedure, saline is infused into the uterus and an ultrasound is obtained to look for any uterine lining abnormalities. Most times, this is accompanied by an endometrial biopsy.
• Dilation & Curettage (D&C): During this procedure, tissue from the lining of the uterus is removed for further evaluation.

Treatment

Treatment of PMB is dependent on your specific diagnosis and medical history. When cancer has been ruled out, treatments may include the use of removal of thickened endometrium via surgery, estrogen creams, removal of polyps, progestin therapy, and/or hysterectomy. Treatment for cancer will depend on the type and stage of cancer diagnosed.

 

Sources:

• HealthLine. Accessed on March 19, 2015
• UpToDate. Accessed on March 21, 2015
• WebMD. Accessed on March 21, 2015