SYMPTOMS

What factors may be associated with postmenopausal bleeding?

Postmenopausal bleeding is related to endocrine disorders, reproductive tract inflammation, and benign or malignant tumors of the reproductive system. Common conditions include senile vaginitis, endometritis, cervical polyps, submucous uterine fibroids, endometrial cancer, and cervical cancer. Postmenopausal bleeding may persist until the underlying cause is resolved, or it may occur irregularly or repeatedly.

TREATMENT

How to Prevent Postmenopausal Bleeding?

• Avoid taking health products containing estrogen/progesterone or unknown ingredients to prevent endocrine disorders that may cause postmenopausal bleeding.
• Remove intrauterine devices promptly after menopause to prevent device-related bleeding.

How to Manage Postmenopausal Bleeding?

Normally, women should not experience vaginal bleeding after menopause. Therefore, if postmenopausal bleeding occurs, patients should seek medical attention immediately to identify the cause and receive targeted treatment rather than blindly stopping the bleeding. During diagnosis and treatment, patients should note the following:

• Blood serves as an ideal medium for bacterial growth, so patients should maintain personal hygiene by bathing frequently and changing underwear regularly.
• Postmenopausal uterine bleeding is usually mild and self-limiting, with the primary goal being to rule out malignancy. Thus, treatment is often unnecessary after excluding malignant tumors (or histologic precancerous lesions).
• Schedule regular check-ups for early detection and timely treatment.

DIAGNOSIS

Under what circumstances should postmenopausal bleeding warrant a hospital visit?

Normally, women do not experience vaginal bleeding after menopause. Therefore, any occurrence of postmenopausal bleeding should prompt immediate medical attention to determine the underlying cause. Particular vigilance is required when accompanied by, but not limited to, the following conditions:

• Heavy bleeding, prolonged or recurrent vaginal bleeding;
• Increased vaginal discharge, foul-smelling discharge, or vulvar itching;
• Vaginal fluid discharge, abdominal pain, or palpable abdominal masses;
• Fever, weight loss, fatigue, or loss of appetite;
• Frequent urination, urgency, painful urination, blood in urine, or difficulty with bowel movements.

POTENTIAL DISEASES

What benign conditions may cause postmenopausal bleeding?

• Endocrine disorders: Such as postmenopausal estrogen replacement therapy or taking health supplements containing estrogen and progesterone. These patients typically experience light bleeding that lasts 2–3 days. Additionally, insufficient estrogen can cause endometrial and vaginal atrophy, leading to minor vaginal bleeding or spotting.
• Reproductive tract infections: Such as atrophic vaginitis or endometritis. These patients usually have light bleeding, possibly accompanied by symptoms like vulvar itching, increased vaginal discharge, or foul-smelling discharge.
• Benign reproductive system tumors: Such as uterine fibroids or benign ovarian tumors.
• Other benign conditions: Endometrial polyps, adenomyosis, cervical polyps, intrauterine devices, urethral caruncle, or uterine apoplexy syndrome (also known as senile endometrial hemorrhagic necrosis, caused by uterine artery sclerosis).
• Other factors: Radiation therapy, anticoagulant use, or excessive intake of soy and other phytoestrogens.

What malignant diseases may be associated with postmenopausal bleeding?

• Reproductive system malignancies: Such as endometrial cancer, cervical cancer, ovarian cancer, fallopian tube cancer, or vulvar cancer. These patients often experience heavy bleeding, persistent bleeding, or recurrent vaginal bleeding.