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Postmenopausal bleeding

MedGen UID:
19421
•Concept ID:
C0032776
•
Pathologic Function
Synonyms: Bleeding after menopause; PMB - Postmenopausal bleeding; Postmenopausal Hemorrhage
SNOMED CT: Postmenopausal bleeding (76742009); PMB - Postmenopausal bleeding (76742009); Bleeding after menopause (76742009)
 
HPO: HP:0033840

Definition

Uterine bleeding that occurs after at least one year of amenorrhea in a woman who is not receiving hormone therapy. [from HPO]

Professional guidelines

PubMed

Risk assessment of endometrial cancer and endometrial intraepithelial neoplasia in women with abnormal bleeding and implications for clinical management algorithms.
Clarke MA, Long BJ, Sherman ME, Lemens MA, Podratz KC, Hopkins MR, Ahlberg LJ, Mc Guire LJ, Laughlin-Tommaso SK, Bakkum-Gamez JN, Wentzensen N
Am J Obstet Gynecol 2020 Oct;223(4):549.e1-549.e13. Epub 2020 Apr 5 doi: 10.1016/j.ajog.2020.03.032. PMID: 32268124Free PMC Article
Clinical management of vaginal bleeding in postmenopausal women.
Carugno J
Climacteric 2020 Aug;23(4):343-349. Epub 2020 Apr 1 doi: 10.1080/13697137.2020.1739642. PMID: 32233689
Diagnosis and Management of Endometrial Cancer.
Braun MM, Overbeek-Wager EA, Grumbo RJ
Am Fam Physician 2016 Mar 15;93(6):468-74. PMID: 26977831

Recent clinical studies

Etiology

Unexpected vaginal bleeding and COVID-19 vaccination in nonmenstruating women.
Blix K, Laake I, Juvet L, Robertson AH, Caspersen IH, Mjaaland S, Skodvin SN, Magnus P, Feiring B, Trogstad L
Sci Adv 2023 Sep 22;9(38):eadg1391. doi: 10.1126/sciadv.adg1391. PMID: 37738335Free PMC Article
Endometrial Hyperplasia.
Ring KL, Mills AM, Modesitt SC
Obstet Gynecol 2022 Dec 1;140(6):1061-1075. Epub 2022 Nov 2 doi: 10.1097/AOG.0000000000004989. PMID: 36357974
Endometrial cancer.
Crosbie EJ, Kitson SJ, McAlpine JN, Mukhopadhyay A, Powell ME, Singh N
Lancet 2022 Apr 9;399(10333):1412-1428. doi: 10.1016/S0140-6736(22)00323-3. PMID: 35397864
Association of Endometrial Cancer Risk With Postmenopausal Bleeding in Women: A Systematic Review and Meta-analysis.
Clarke MA, Long BJ, Del Mar Morillo A, Arbyn M, Bakkum-Gamez JN, Wentzensen N
JAMA Intern Med 2018 Sep 1;178(9):1210-1222. doi: 10.1001/jamainternmed.2018.2820. PMID: 30083701Free PMC Article
Diagnosis and Management of Endometrial Cancer.
Braun MM, Overbeek-Wager EA, Grumbo RJ
Am Fam Physician 2016 Mar 15;93(6):468-74. PMID: 26977831

Diagnosis

Endometrial Hyperplasia.
Ring KL, Mills AM, Modesitt SC
Obstet Gynecol 2022 Dec 1;140(6):1061-1075. Epub 2022 Nov 2 doi: 10.1097/AOG.0000000000004989. PMID: 36357974
Risk assessment of endometrial cancer and endometrial intraepithelial neoplasia in women with abnormal bleeding and implications for clinical management algorithms.
Clarke MA, Long BJ, Sherman ME, Lemens MA, Podratz KC, Hopkins MR, Ahlberg LJ, Mc Guire LJ, Laughlin-Tommaso SK, Bakkum-Gamez JN, Wentzensen N
Am J Obstet Gynecol 2020 Oct;223(4):549.e1-549.e13. Epub 2020 Apr 5 doi: 10.1016/j.ajog.2020.03.032. PMID: 32268124Free PMC Article
Clinical management of vaginal bleeding in postmenopausal women.
Carugno J
Climacteric 2020 Aug;23(4):343-349. Epub 2020 Apr 1 doi: 10.1080/13697137.2020.1739642. PMID: 32233689
Association of Endometrial Cancer Risk With Postmenopausal Bleeding in Women: A Systematic Review and Meta-analysis.
Clarke MA, Long BJ, Del Mar Morillo A, Arbyn M, Bakkum-Gamez JN, Wentzensen N
JAMA Intern Med 2018 Sep 1;178(9):1210-1222. doi: 10.1001/jamainternmed.2018.2820. PMID: 30083701Free PMC Article
Diagnosis and Management of Endometrial Cancer.
Braun MM, Overbeek-Wager EA, Grumbo RJ
Am Fam Physician 2016 Mar 15;93(6):468-74. PMID: 26977831

Therapy

Postmenopausal bleeding after COVID-19 vaccination.
Kauffman TL, Irving SA, Brooks N, Vesco KK, Slaughter M, Smith N, Tepper NK, Olson CK, Weintraub ES, Naleway AL; Vaccine Safety Datalink Menstrual Irregularities Workgroup
Am J Obstet Gynecol 2024 Jan;230(1):71.e1-71.e14. Epub 2023 Sep 17 doi: 10.1016/j.ajog.2023.09.007. PMID: 37726057
Unexpected vaginal bleeding and COVID-19 vaccination in nonmenstruating women.
Blix K, Laake I, Juvet L, Robertson AH, Caspersen IH, Mjaaland S, Skodvin SN, Magnus P, Feiring B, Trogstad L
Sci Adv 2023 Sep 22;9(38):eadg1391. doi: 10.1126/sciadv.adg1391. PMID: 37738335Free PMC Article
Covid-19 vaccination and postmenopausal bleeding.
Taylor A, Male V
BMJ 2023 May 17;381:1122. doi: 10.1136/bmj.p1122. PMID: 37197776
Endometrial bleeding in postmenopausal women: with and without hormone therapy.
Archer DF
Menopause 2011 Apr;18(4):416-20. doi: 10.1097/gme.0b013e31820ca808. PMID: 21701426
Postmenopausal bleeding.
Gambrell RD Jr
Clin Obstet Gynaecol 1977 Apr;4(1):129-43. PMID: 852206

Prognosis

Endometrial cancer.
Crosbie EJ, Kitson SJ, McAlpine JN, Mukhopadhyay A, Powell ME, Singh N
Lancet 2022 Apr 9;399(10333):1412-1428. doi: 10.1016/S0140-6736(22)00323-3. PMID: 35397864
Risk assessment of endometrial cancer and endometrial intraepithelial neoplasia in women with abnormal bleeding and implications for clinical management algorithms.
Clarke MA, Long BJ, Sherman ME, Lemens MA, Podratz KC, Hopkins MR, Ahlberg LJ, Mc Guire LJ, Laughlin-Tommaso SK, Bakkum-Gamez JN, Wentzensen N
Am J Obstet Gynecol 2020 Oct;223(4):549.e1-549.e13. Epub 2020 Apr 5 doi: 10.1016/j.ajog.2020.03.032. PMID: 32268124Free PMC Article
Presenting symptoms of cancer and stage at diagnosis: evidence from a cross-sectional, population-based study.
Koo MM, Swann R, McPhail S, Abel GA, Elliss-Brookes L, Rubin GP, Lyratzopoulos G
Lancet Oncol 2020 Jan;21(1):73-79. Epub 2019 Nov 6 doi: 10.1016/S1470-2045(19)30595-9. PMID: 31704137Free PMC Article
Association of Endometrial Cancer Risk With Postmenopausal Bleeding in Women: A Systematic Review and Meta-analysis.
Clarke MA, Long BJ, Del Mar Morillo A, Arbyn M, Bakkum-Gamez JN, Wentzensen N
JAMA Intern Med 2018 Sep 1;178(9):1210-1222. doi: 10.1001/jamainternmed.2018.2820. PMID: 30083701Free PMC Article
Diagnosis and Management of Endometrial Cancer.
Braun MM, Overbeek-Wager EA, Grumbo RJ
Am Fam Physician 2016 Mar 15;93(6):468-74. PMID: 26977831

Clinical prediction guides

Symptom-related Ki-67 expression in endometrial polyps.
Atak Z, Turhan EI, Rahimli Ocakoglu S, Uyaniklar OO
Eur J Obstet Gynecol Reprod Biol 2022 May;272:139-143. Epub 2022 Mar 12 doi: 10.1016/j.ejogrb.2022.03.022. PMID: 35307614
An overview of the main intrauterine pathologies in the postmenopausal period.
Manchanda R, Thapa S
Climacteric 2020 Aug;23(4):384-387. Epub 2020 Jun 10 doi: 10.1080/13697137.2020.1776694. PMID: 32520598
Risk assessment of endometrial cancer and endometrial intraepithelial neoplasia in women with abnormal bleeding and implications for clinical management algorithms.
Clarke MA, Long BJ, Sherman ME, Lemens MA, Podratz KC, Hopkins MR, Ahlberg LJ, Mc Guire LJ, Laughlin-Tommaso SK, Bakkum-Gamez JN, Wentzensen N
Am J Obstet Gynecol 2020 Oct;223(4):549.e1-549.e13. Epub 2020 Apr 5 doi: 10.1016/j.ajog.2020.03.032. PMID: 32268124Free PMC Article
Association of Endometrial Cancer Risk With Postmenopausal Bleeding in Women: A Systematic Review and Meta-analysis.
Clarke MA, Long BJ, Del Mar Morillo A, Arbyn M, Bakkum-Gamez JN, Wentzensen N
JAMA Intern Med 2018 Sep 1;178(9):1210-1222. doi: 10.1001/jamainternmed.2018.2820. PMID: 30083701Free PMC Article
No. 249-Asymptomatic Endometrial Thickening.
Wolfman W
J Obstet Gynaecol Can 2018 May;40(5):e367-e377. doi: 10.1016/j.jogc.2018.03.005. PMID: 29731210

Recent systematic reviews

Ultrasound detection of endometrial cancer in women with postmenopausal bleeding: Systematic review and meta-analysis.
Long B, Clarke MA, Morillo ADM, Wentzensen N, Bakkum-Gamez JN
Gynecol Oncol 2020 Jun;157(3):624-633. Epub 2020 Jan 31 doi: 10.1016/j.ygyno.2020.01.032. PMID: 32008795
Association of Endometrial Cancer Risk With Postmenopausal Bleeding in Women: A Systematic Review and Meta-analysis.
Clarke MA, Long BJ, Del Mar Morillo A, Arbyn M, Bakkum-Gamez JN, Wentzensen N
JAMA Intern Med 2018 Sep 1;178(9):1210-1222. doi: 10.1001/jamainternmed.2018.2820. PMID: 30083701Free PMC Article
The accuracy of endometrial sampling in women with postmenopausal bleeding: a systematic review and meta-analysis.
van Hanegem N, Prins MM, Bongers MY, Opmeer BC, Sahota DS, Mol BW, Timmermans A
Eur J Obstet Gynecol Reprod Biol 2016 Feb;197:147-55. Epub 2015 Dec 19 doi: 10.1016/j.ejogrb.2015.12.008. PMID: 26748390
Prediction models in women with postmenopausal bleeding: a systematic review.
van Hanegem N, Breijer MC, Opmeer BC, Mol BW, Timmermans A
Womens Health (Lond) 2012 May;8(3):251-62. doi: 10.2217/whe.12.10. PMID: 22554173
Endometrial thickness measurement for detecting endometrial cancer in women with postmenopausal bleeding: a systematic review and meta-analysis.
Timmermans A, Opmeer BC, Khan KS, Bachmann LM, Epstein E, Clark TJ, Gupta JK, Bakour SH, van den Bosch T, van Doorn HC, Cameron ST, Giusa MG, Dessole S, Dijkhuizen FPHLJ, Ter Riet G, Mol BWJ
Obstet Gynecol 2010 Jul;116(1):160-167. doi: 10.1097/AOG.0b013e3181e3e7e8. PMID: 20567183

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