gynecology and obstetrics
Vaginal Bleeding
Geriatrics Essentials
Postmenopausal bleeding (bleeding > 12 months after the final menstrual period) is abnormal and requires further evaluation to exclude cancer, unless it clearly results from withdrawal of exogenous hormones. In women not taking exogenous hormones, the most common cause of postmenopausal bleeding is endometrial atrophy, but endometrial pathology should still be ruled out. In some older women, physical examination of the vagina can be difficult because lack ofestrogenleads to increased friability of the vaginal mucosa, vaginal stenosis, and sometimes adhesions in the vagina. For these patients, a pediatric speculum may be more comfortable. 