Chapter 29 POSTMENOPAUSAL VAGINAL BLEEDING
Postmenopausal bleeding may be defined as vaginal bleeding starting 12 months or more after the cessation of menses or unscheduled bleeding in a postmenopausal woman who has been taking hormone replacement therapy for 12 months or more. All women with postmenopausal bleeding should be evaluated for potential malignancy, including endometrial cancer, premalignant atypical endometrial hyperplasia, and cervical cancer.
Hysteroscopy is the “gold standard” for the evaluation of postmenopausal bleeding because of the ability to perform directed biopsy. The limitations of hysteroscopy are the invasive nature of the procedure, the requirement for expensive equipment, and the risks associated with general anesthesia.