Postmenopausal Vaginal Bleeding

Published on 06/06/2015 by admin

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Last modified 06/06/2015

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Chapter 118 Postmenopausal Vaginal Bleeding

INTRODUCTION

Description: As a symptom only, postmenopausal bleeding—vaginal bleeding that occurs in women who have passed menopause—requires evaluation to rule out processes that may threaten the long-term health of the patient.

Prevalence: Common.

Predominant Age: 50 or older.

Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: Systemic—estrogen, estrogen/progesterone, thrombocytopenia. Uterine—endometrial cancer, endometrial hyperplasia, endometritis, submucous leiomyomata. Cervical sources—carcinoma, cervical eversion, cervicitis, condyloma, polyps. Vaginal sources—adenosis, atrophic change, carcinoma, foreign bodies (condom, pessary, tampon), infection, lacerations (coital injury, trauma). Vulvar and extragenital sources—atrophy, condyloma, cystitis/urethritis, gastrointestinal (cancer, diverticulitis, inflammatory bowel disease), hematuria, hemorrhoids, infection, labial varices, neoplasm, trauma, urethral caruncle, urethral diverticula, urethral prolapse/eversion.

Risk Factors: Estrogen replacement therapy, others based on specific pathologic conditions.

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Painless vaginal bleeding (spontaneous or iatrogenic)

• Pink or dark discharge noted on the underwear or when wiping after urination

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Netters Obstetrics and Gynecology