Question of the Week # 366

366)  A 59 year old woman is evaluated in your office for vaginal bleeding. The patient has not had a menstrual period for the past eight years. She  has never taken hormone replacement therapy. Over the past 6 months she has had several episodes of spotting. The bleeding is more pronounced after sexual activity. Physical examination including pelvic examination is unremarkable. Which of the following is the most common cause of post-menopausal bleeding?

A) Endometrial Carcinoma

B) Endometrial Hyperplasia

C) Cervical polyps

D) Vaginal Atrophy

E) Fibroids

6 Responses

  1. D) Vaginal Atrophy

  2. d

  3. c, post-coital bleeding suggests cervical lesion

  4. Most common cause of post menopausal bleeding is Vaginal atrophy. Post-coital bleeding may be due to trauma to atrophic vagina leading to bleeding.

  5. DDDD,,,,, this is from uptodate,,,,

    “The differential diagnosis of bleeding in postmenopausal women is less broad than that for abnormal bleeding in premenopausal women since the various causes of anovulation are not relevant. A series of 1138 women age 41 to 91 years with postmenopausal bleeding (n = 351 on postmenopausal hormone therapy) reported the following types and frequency of histopathology [2]:

    Atrophy (59 percent)
    Polyps (12 percent)
    Endometrial cancer (10 percent)
    Endometrial hyperplasia (9.8 percent)
    Hormonal effect (7 percent)
    Cervical cancer (less than 1 percent)
    Other (eg, hydrometra, pyometra, hematometra: 2 percent)

  6. DDD

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