Postmenopausal Bleeding (PMB)
Definition:
Postmenopausal bleeding (PMB) refers to vaginal bleeding that occurs 12 months or more after menopause, following the depletion of ovarian follicles. Any vaginal bleeding in a menopausal woman is abnormal and must always be investigated, as it is often associated with an underlying pathology.
Causes of Postmenopausal Bleeding
Diagnostic Approach
To determine the source of bleeding, the following investigations are recommended:
• Pelvic examination in theatre (preferably under anesthesia) to assess the source of bleeding.
• Biopsy of suspicious areas, including vaginal, cervical, and endometrial tissue.
• Hysteroscopy, if available, to visualize and assess the uterine cavity.
• Pelvic ultrasound to evaluate ovarian and endometrial pathology.
Management
Treatment is directed at the underlying cause of bleeding. For atrophic vaginitis, topical estrogen therapy is the standard management. Other conditions require individualized treatment based on the specific diagnosis.
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