Chapter 118 Postmenopausal Vaginal Bleeding
INTRODUCTION
Description: As a symptom only, postmenopausal bleeding—vaginal bleeding that occurs in women who have passed menopause—requires evaluation to rule out processes that may threaten the long-term health of the patient.
ETIOLOGY AND PATHOGENESIS
Causes: Systemic—estrogen, estrogen/progesterone, thrombocytopenia. Uterine—endometrial cancer, endometrial hyperplasia, endometritis, submucous leiomyomata. Cervical sources—carcinoma, cervical eversion, cervicitis, condyloma, polyps. Vaginal sources—adenosis, atrophic change, carcinoma, foreign bodies (condom, pessary, tampon), infection, lacerations (coital injury, trauma). Vulvar and extragenital sources—atrophy, condyloma, cystitis/urethritis, gastrointestinal (cancer, diverticulitis, inflammatory bowel disease), hematuria, hemorrhoids, infection, labial varices, neoplasm, trauma, urethral caruncle, urethral diverticula, urethral prolapse/eversion.
