Light bleeding one year after menopause

A small amount of bleeding one year after menopause is a common symptom. It can be physiological or pathological. Therefore, when this symptom occurs, do not be careless and go to the hospital for diagnosis and treatment in time. This symptom may occur when there is inflammation, such as endometritis. This symptom can also occur when you have endometrial cancer. Let us now take a closer look at what causes minor bleeding one year after menopause.

Generally, after the age of 50, women’s menstruation stops for more than one year, which is called menopause. Vaginal bleeding after menopause is called postmenopausal bleeding. Postmenopausal bleeding is generally caused by the following reasons.

Postmenopausal bleeding caused by vaginal and cervical factors is generally not difficult to make a clear diagnosis through detailed medical history, gynecological examination, cervical cytology and histological examination. Causes of bleeding caused by uterine factors, benign lesions such as endometrial atrophy, endometritis, endometrial polyps, submucosal fibroids, endometrial hyperplasia and functional changes caused by hormone replacement therapy. Malignant lesions include endometrial cancer, uterine sarcoma, etc.

Postmenopausal bleeding caused by endogenous or exogenous estrogens. After menopause, the physiological function of the ovaries gradually declines, causing estrogen levels to drop and unable to support the effective growth of the endometrium. However, the endometrium of postmenopausal women still responds to estrogen. After menopause, both the ovarian stroma and the adrenal cortex can secrete androgens, which are converted into estrone. Therefore, fluctuations in estrogen levels can cause vaginal bleeding. Similarly, the endometrium can also cause bleeding when it is exposed to external estrogen.

Malignant diseases: such as endometrial cancer, cervical adenocarcinoma, uterine sarcoma, ovarian malignancy, etc.

Bleeding caused by benign organic lesions: Common ones include endometritis, intrauterine contraceptive device, submucosal uterine fibroids, benign ovarian tumors, cervical polyps, urethral caruncle, senile vaginitis, etc.

Laboratory tests

1. Hysteroscopic examination The diagnostic accuracy of fiberoptic hysteroscopy is higher than that of TVS. TVS may miss local hyperplastic lesions and adenocarcinoma. Even the endometrial findings detected by TVS and SHSG need to be directly biopsied under hysteroscopy. Therefore, fiberoptic hysteroscopy is better than vaginal ultrasound for the examination of lesions of perimenopausal and postmenopausal uterine bleeding. There are four reasons: First, the thickness of the double-layer endometrium without hormone treatment is <4mm. The misdiagnosis rate of abnormal endometrium in vaginal ultrasound examination is 5.5%, while the accuracy rate of positioning biopsy under fiberoptic hysteroscopy is higher than 94%; second, the early stages of endometrial hyperplasia and endometrial adenocarcinoma are both focal, which are easily missed by vaginal ultrasound, while fiberoptic hysteroscopy can be observed and biopsied under direct vision; third, sometimes more than two biopsies are required to determine the extension range of the tumor or lesion. Fiberoptic hysteroscopy can be explored under direct vision and multiple biopsies can be performed; fourth, abnormal findings on vaginal ultrasound require pathological confirmation, while fiberoptic hysteroscopy can be directly biopsied.

2. TVS is a non-invasive examination method often used to screen the causes of postmenopausal uterine bleeding. Karlsson studied PMB in which TVS showed no abnormalities, endometrium ≤4nn, and hysteroscopy found 1 case of small endometrial polyp; in 39 cases with endometrium >4mm, TVS suggested endometrial abnormalities, hysteroscopy only confirmed 35 cases, and 4 cases were false positives; in 9 cases with endometrium ≥8mm, hysteroscopy showed endometrial polyps in 8 cases, and 1 case was endometrial polyp or submucosal myoma. Taking pathological findings as the final diagnosis, the sensitivity, specificity, positive predictive value, and negative predictive value of TVS were 100%, 75%, 90%, and 100%, respectively, and the corresponding values ​​for hysteroscopy were 97%, 88%, 94%, and 93%, respectively. Therefore, it is believed that TVS screening can be performed before laparoscopy. O'Connell et al. reported that the results of TVS and hysteroscopic tissue biopsy were consistent with surgery in >90%, the sensitivity of TVS was 94%, the specificity was 96%, and no endometrial hyperplasia or cancer was missed. They believed that this method is a reliable tool for outpatient evaluation of PMB. Granberg believes that TVS can be used as the first step in routine examinations to evaluate PMB. When ultrasound images are abnormal or uncertain, or when ultrasound images are normal but the patient continues to have symptoms, hysteroscopy must be performed, and further endoscopic biopsy must be performed to exclude or show pathological conditions.