Postmenopausal Bleeding

Many women are unaware that spontaneous postmenopausal bleeding is not considered normal. As women, we go through life expecting a monthly cycle, so if it returns after a year or more of absence, many of us will laugh it off or feel slightly annoyed. However, this can be a sign of a condition called endometrial hyperplasia (EM). EM a condition that is easily treated, but when left untreated can lead to cancer of the uterus. It can also be the first sign of cervical or uterine cancer.

The endometrium is the tissue lining the uterine wall. It is this tissue that thickens each month, readying the uterus for implantation of a fertilized egg. If an egg is not fertilized, then the lining sloughs off and results in menstruation. If instead, the lining becomes too thick, the cells can become atypical and potentially cause cancer.

Risk factors include:

  • Age older than 35 years
  • White race
  • Infertility or never having been pregnant
  • Older age at menopause (the average age of menopause in the US is 51 years of age)
  • Early age when menstruation first started (the average age of menarche is 12.5 years of age)
  • Personal history of conditions, such as diabetes mellitus, polycystic ovary syndrome, gallbladder disease, or thyroid disease
  • Chronically overweight
  • Tobacco use
  • Family history of ovarian, colon, or uterine cancer


  • Transvaginal ultrasound
  • Endometrial biopsy, dilation & curettage (D & C), or hysteroscopy.

Treatment Options:

  • Progestin, a sex hormone, can be given orally, administered through injection, applied topically or through the use of a progesterone-releasing intrauterine device (IUD).
  • Atypical hyperplasia, particularly complex atypical hyperplasia, significantly increases the risk of cancer. In this case, hysterectomy is usually the best treatment option if you do not want to have any more children.


Seek consultation with your doctor if you’re experiencing postmenopausal bleeding to ensure many healthy years ahead.

Categories direct primary care, hormones, menopause, prevention, Uncategorized, weight

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