What is Post Menopausal Bleeding [PMB]?
Postmenopausal bleeding is defined as vaginal bleeding occurring over 12 months after periods have stopped in a woman of the age where the menopause can be expected. Hence it does not apply to a young woman who has had amenorrhoea from anorexia nervosa or a pregnancy followed by lactation. It can apply to younger women following premature ovarian failure or premature menopause.
It is common and represents 5% of all gynaecology OPD attendances.
It is likely to occur if exogenous oestrogens are taken. Polycystic ovary disease increases risk. Use of combined oral contraceptives decreases risk.
History and examination may possibly indicate cause but the dictum is that postmenopausal bleeding should be treated as malignant [cancer] until proved otherwise. This requires urgent evaluation by a qualified gynaecologist.
A paper from San Francisco looked at postmenopausal women, with and without PMB but not taking HRT. They found that in a postmenopausal woman with vaginal bleeding, the risk of cancer is approximately 7.3% if her endometrium is 5 mm thick or more and less than 0.07% if it is less than 5 mm. In a postmenopausal women without vaginal bleeding, the risk of cancer is approximately 6.7% if the endometrium is over 10mm thick and 0.002% if the endometrium is less than 10 mm. They estimated that around 5% of women with endometrial cancer do not have PMB. If the endometrium is over 11mm thick the risk of cancer rises from 4.1% at age 50 to 9.3% at age 79
The accuracy of assessing endometrial thickness in women with diabetes and obesity has been questioned.
Important points to keep in mind: