Postmenopausal Bleeding

What it is

Postmenopausal bleeding is any loss of blood from the vagina that occurs after twelve consecutive months without a period. Even if it's small, a single occurrence, or just a brown spot, it always needs to be investigated. Most of the time the cause is benign, such as atrophy of the endometrium and vagina from lack of estrogen, polyps, or the use of hormone therapy. But in about one in ten women, the bleeding is the first sign of endometrial hyperplasia or cancer, which, when caught early, has a high chance of cure. The gynecology team at Femi Saúde investigates the bleeding promptly and manages treatment according to the cause.

Most common symptoms

• Any bleeding after a year without a period
• Pink or brown spots on underwear
• Bleeding after intercourse
• Watery discharge or discharge streaked with blood
• Dryness, burning and pain during intercourse, when there's atrophy
• Pelvic pain, in some cases

Causes and risk factors

• Atrophy of the endometrium and vagina from lack of estrogen
• Endometrial or cervical polyps
• Menopausal hormone therapy, especially at the start
• Endometrial hyperplasia
• Cancer of the endometrium, cervix or vulva
• Infections and lesions of the cervix or vagina

How it is diagnosed

The investigation is done without delay. The gynecologist records the characteristics of the bleeding, the use of hormone therapy or tamoxifen, and risk factors such as obesity, diabetes, and family history. The gynecological exam inspects the vulva, vagina, and cervix, and the Pap smear is updated. Transvaginal ultrasound measures endometrial thickness: when thin, an atrophic cause is likely; when thick or irregular, or if bleeding persists, diagnostic hysteroscopy with endometrial biopsy is indicated to examine the uterine cavity and obtain tissue for analysis. The results determine the approach.

How we treat it at Femi Saúde

Treatment depends on the cause found. For atrophy, low-dose vaginal estrogen relieves symptoms and prevents further episodes; when bleeding occurs during hormone therapy, the gynecology team at Femi Saúde adjusts the regimen. Polyps are removed by surgical hysteroscopy and sent for analysis. Endometrial hyperplasia without atypia can be treated with progestogens or the hormonal IUD, with follow-up biopsies; with atypia, hysterectomy is usually indicated. When cancer is diagnosed, the patient is promptly referred to gynecologic oncology, with joint follow-up. The plan is individualized and determined after the complete work-up.

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