Postmenopausal Bleeding

Causes and Significance

The most common cause is genitourinary atrophy, where low estrogen leads to thinning and fragility of the vaginal and endometrial lining, causing spotting or light bleeding. Other causes include endometrial or cervical polyps, fibroids, endometrial hyperplasia, hormone therapies, infections, and genital tract malignancies such as endometrial or cervical cancer.?

Clinical Features and Evaluation

Bleeding can range from light staining on underwear or toilet paper to flow resembling a period, sometimes with clots or bleeding after intercourse. Evaluation typically includes pelvic examination, transvaginal ultrasound to assess endometrial thickness, and endometrial sampling or hysteroscopy if the lining is thickened or risk factors are present.?

Management

Treatment depends on the cause: topical estrogen and lubricants for atrophy, hysteroscopic removal of polyps, medical or surgical management for hyperplasia, and oncologic treatment for cancers. Any episode of postmenopausal bleeding warrants urgent consultation with a gynecologist rather than watchful waiting.