Preparing for practice Postmenopausal bleeding.(Disease/Disorder overview)

Publication: Update

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Postmenopausal bleeding (PMB) is vaginal bleeding that occurs more than 12 months after the last natural period in women who are not using hormone therapies. The term would not be applied to women who have spells of amenorrhoea due to anorexia, pregnancy and lactation, or endometrial suppression with the levonorgestrel releasing intrauterine device (LNG IUD). It may be very appropriately used where young women have had premature ovarian failure whether due to spontaneous or iatrogenic reasons. Postmenopausal bleeding is common, with primary care consultation rates of 14.3/1000 population. It is important to be aware that some women may not be able to differentiate between vaginal, urethral or even rectal blood loss. All reports should be taken seriously. Post menopausal bleeding should signal malignancy until proven to be innocent. Between 3-10% (depending on the population studied) will have endometrial cancer. This means that in the majority of presentations, there will be a benign explanation or even no explanation at all. Occasionally, cancer may be uncovered in systems other than those initially investigated. It may also co-exist alongside other benign conditions. We aim not to miss endometrial cancer, which in 95% of cases presents with postmenopausal bleeding. It is the most common female genital malignancy, with nearly 4000 new diagnoses each year in England and Wales and a rising incidence. Unlike other gynaecological cancers, it generally presents early in its natural history. Stage I cancer that is confined to the endometrium or with only partial invasion of the muscle layer (myometrium) can usually be definitively treated by hysterectomy, with radiotherapy or chemotherapy rarely required. The 5 year survival is good and women who are disease free at 5 years are unlikely to see a later recurrence. Unfortunately, there are no new treatments available for late stage disease, so early detection and treatment are crucially important. Post menopausal bleeding is therefore one of the presentations identified...

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