EC Microbiology

Introduction:Post-menopausal bleeding (PMB) is defined as uterine bleeding that occurs after one year of menopause. Amenor- rhoea accounts for 10% of incidence immediately after menopause. One of the other common reasons for post-menstrual bleeding is endometrial carcinoma which occurs in 10 - 15% of cases. Endometrial Cancer, unlike ovarian cancer, presents at an early stage can be treated with hysterectomy, provided timely and accurate diagnosis is made. It is important to notice that lesions such as endo- metrial polyps, fibroids (benign focal lesions) and vaginal atrophy are some common reasons for post-menstrual bleeding, which is prevalent in up to 40% of cases. Risk factors include obesity, polycystic ovary syndrome, unopposed estrogens, and nulliparity. Post- menopausal bleeding mostly has an intrauterine source, but vulva, vagina, cervix, fallopian tubes, or ovarian pathology and cervical stenosis may be some other reasons. The extragenital sites for bleeding are the urethra or bladder and the rectum or bowel. There- fore, a prompt clinical approach is mandatory to evaluate the cause of post-menopausal bleeding and to exclude it from carcinoma of the genital tract or other precancerous lesions of the endometrium.

Aim and Scope:The aim of the review is to understand the various possible causative factors for post-menopausal bleeding and its management.

Methodology:The review is a comprehensive research of PUBMED from the year 2012 to 2021.

Conclusion:There may be multiple reasons for Post-menopausal bleeding, and 10% of them are due to endometrial carcinoma; therefore, post-menopausal bleeding must always be investigated to rule out the cause, the most common among that is atrophic vaginitis or endometritis. Tissue pathology for assessment of endometrium is essential, even if there is an obvious presence of atro- phic vaginitis or polyp. Most of the causative factors can be treated well if diagnosed early and present lesser complication; the prognosis for carcinoma is also usually good since most patients present at an early stage of disease attributed to its early symptom of post-menopausal bleeding.

 Keywords: Post-Menopausal Vaginal Bleeding; Carcinoma; Management; Hysterectomy

1. Sung S and Abramovitz A. “Post-menopausal Bleeding”. Stat Pearls (2021).
2. Smith PP., et al. “Recurrent post-menopausal bleeding: a prospective cohort study”. Journal of Minimally Invasive Gynecology 21.5 (2014): 799-803.
3. Lurain J. “Uterine cancer”. In: Berek JS, Adashi EY, Hillard PA, editors. Novak’s Gynecology 12th edition. Baltimore: Williams and Wilkins (1996): 1057-1110.
4. Astrup K and Olivarius NDF. “Frequency of spontaneously occurring post-menopausal bleeding in the general population”. Acta Obstetricia Et Gynecologica Scandinavica 83.2 (2004): 203-207.
5. Ferenczy A. “Pathophysiology of endometrial bleeding”. Maturitas 45.1 (2003): 1-14.
6. Van Hunsel F P and Kampschöer P. “Postmenopausal bleeding and dietary supplements: a possible causal relationship with hop-and-soy-containing preparations”. Nederlands Tijdschrift Voor Geneeskunde 156.41 (2012): A5095-A5095.
7. American College of Obstetricians and Gynecologists. ACOG committee opinion no. 734: the role of transvaginal ultrasonography in evaluating the endometrium of women with post-menopausal bleeding”. Obstetrics and Gynecology 131.5 (2018): e124-e129.
8. Bakour S H., et al. “Management of women with post-menopausal bleeding: evidence-based review”. The Obstetrician and Gynaecologist 14.4 (2012): 243-249.
9. Reijnen C., et al. “Diagnostic accuracy of endometrial biopsy in relation to the amount of tissue”. Journal of Clinical Pathology 70.11 (2017): 941-946.
10. Kaan M. “Arguments and counter-arguments about the orthodontic treatment of missing incisors. Literature review”. The Fogorvosi Szemle 103.3 (2010): 83-88.
11. Parkash V., et al. “Committee Opinion No. 631: endometrial intraepithelial neoplasia”. Obstetrics and Gynecology 126.4 (2015): 897.
12. Ricciardi E., et al. “Clinical factors and malignancy in endometrial polyps. Analysis of 1027 cases”. European Journal of Obstetrics and Gynecology and Reproductive Biology 183 (2014): 121-124.
13. Di Caprio R., et al. “Anti-inflammatory properties of low and high doxycycline doses: an in vitro study”. Mediators of Inflammation (2015): 329418.
14. Sasaki LMP., et al. “Factors associated with malignancy in hysteroscopically resected endometrial polyps: a systematic review and meta-analysis”. Journal of Minimally Invasive Gynecology 25.5 (2018): 777-785.
15. Practice Bulletin No. 149: Endometrial cancer”. Obstetrics and Gynecology 125.4 (2015): 1006-1026.
16. Benedet J L., et al. “Staging classifications and clinical practice guidelines for gynaecological cancers”. International Journal of Gynecology and Obstetrics 70 (2000): 207-312.