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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

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
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
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
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
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

Therapy

Covid-19 vaccination and postmenopausal bleeding.
Taylor A, Male V
BMJ 2023 May 17;381:1122. doi: 10.1136/bmj.p1122. PMID: 37197776
The significance of "atrophic endometrium" in women with postmenopausal bleeding.
Rotenberg O, Goldberg GL
Arch Gynecol Obstet 2022 Sep;306(3):579-583. doi: 10.1007/s00404-022-06540-1. PMID: 35318501
Levonorgestrel intrauterine system for endometrial protection in women with breast cancer on adjuvant tamoxifen.
Romero SA, Young K, Hickey M, Su HI
Cochrane Database Syst Rev 2020 Dec 21;12(12):CD007245. doi: 10.1002/14651858.CD007245.pub4. PMID: 33348436Free PMC Article
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

Menstrual irregularities and vaginal bleeding after COVID-19 vaccination reported to v-safe active surveillance, USA in December, 2020-January, 2022: an observational cohort study.
Wong KK, Heilig CM, Hause A, Myers TR, Olson CK, Gee J, Marquez P, Strid P, Shay DK
Lancet Digit Health 2022 Sep;4(9):e667-e675. Epub 2022 Aug 9 doi: 10.1016/S2589-7500(22)00125-X. PMID: 35961858Free PMC Article
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
ACOG Committee Opinion No. 734: The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Women With Postmenopausal Bleeding.
Obstet Gynecol 2018 May;131(5):e124-e129. doi: 10.1097/AOG.0000000000002631. PMID: 29683909
Asymptomatic endometrial thickening.
Wolfman W, Leyland N, Heywood M, Singh SS, Rittenberg DA, Soucy R, Allaire C, Awadalla A, Best C, Dunn S, Leroux N, Potestio F, Senikas V, Wallace S, Menzies R; Society of Obstetricians and Gynaecologists of Canada
J Obstet Gynaecol Can 2010 Oct;32(10):990-9. doi: 10.1016/s1701-2163(16)34690-4. PMID: 21176311

Recent systematic reviews

Levonorgestrel intrauterine system for endometrial protection in women with breast cancer on adjuvant tamoxifen.
Romero SA, Young K, Hickey M, Su HI
Cochrane Database Syst Rev 2020 Dec 21;12(12):CD007245. doi: 10.1002/14651858.CD007245.pub4. PMID: 33348436Free 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
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
Diagnostic hysteroscopy in abnormal uterine bleeding: a systematic review and meta-analysis.
van Dongen H, de Kroon CD, Jacobi CE, Trimbos JB, Jansen FW
BJOG 2007 Jun;114(6):664-75. doi: 10.1111/j.1471-0528.2007.01326.x. PMID: 17516956

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