Clinical management of vaginal bleeding in postmenopausal women

Abstract

Menopause is characterized by permanent cessation of menstrual periods and is clinically diagnosed after 12 months of complete amenorrhea. It occurs at a median age of 51 years alongside the physiological process of aging, although it can happen at an earlier age for other medical conditions or after surgery (surgical menopause). Due to reduced circulating estrogens and progesterone, the reproductive organs undergo progressive atrophy. This physiologic process of aging is also present at an endometrial level; without the cyclic hormonal actions of the menstrual cycle, the endometrium during menopause becomes atrophic. Postmenopausal bleeding (PMB) is a common gynecologic complaint encountered by the clinician. Endometrial cancer is present in about 10% of patients with PMB. Nevertheless, many other conditions, such as endometrial or cervical polyps, genital atrophy, or non-gynecologic conditions, may also be present. Historically, dilation and curettage (D&C) was the main diagnostic procedure in patients with PMB; however, newer methods of investigation have replaced D&C. The aim of this review is to present an up-to-date analysis of the current evidence for the clinical management of vaginal bleeding in postmenopausal women.

摘要

绝经的特征是月经周期的永久停止, 连续12个月的闭经后才做此临床诊断。绝经的中位数年龄为51岁, 同时伴有生理衰老, 但因其他疾病或手术后（手术后绝经）也可能发生。由于循环中的雌激素和孕酮减少, 生殖器官发生进行性萎缩。这一生理过程的老化也存在于子宫内膜水平；没有月经周期的周期性激素作用, 绝经后子宫内膜也相应萎缩。绝经后出血（PMB）是临床医生经常遇到的妇科疾病。10%的PMB患者存在子宫内膜癌。然而, 许多其他情况, 如子宫内膜或宫颈息肉, 生殖器萎缩, 或非妇科疾病, 也会引起PMB。在过去, 诊刮术(D&C)是PMB患者的主要诊断步骤；然而现在新的研究方法已经取代了D&C。这篇综述的目的是为绝经后妇女阴道出血的临床治疗提供最新的证据分析。

Keywords:

• Menopause
• hysteroscopy
• postmenopausal bleeding
• atrophic endometrium
• endometrial thickness

Potential conflict of interest

No conflict of interest to disclose.

Source of funding

Nil.