Management of postmenopausal bleeding

Postmenopausal genital bleeding is a symptom that requires thorough evaluation. In most cases the cause is benign. Nongenital and nonuterine causes will be found occasionally and should be managed accordingly. The principal thrust of management involves thorough history, examination, and interpretation of endometrial histology. The latter is especially necessary to exclude the most significant, but not most common, cause of postmenopausal bleeding, i.e., adenocarcinoma of the endometrium. Estrogen therapy contributes to postmenopausal bleeding and is usually contraindicated in such cases. Endometrial hyperplasia is considered a precursor lesion to endometrial carcinoma, but the incidence of progression is not great. Thus a scheme of conservative management that relies on repeat histologic examination of the endometrium to determine the biologic potential of endometrial hyperplasia is recommended. Although hospital D&C of the uterus is the traditional accepted method of evaluating the endometrium, there are persuasive reasons to consider suction endometrial biopsy as an appropriate alternative in most patients presenting with postmenopausal bleeding.