Postmenopausal bleeding (PMB) is defined as any vaginal bleeding occurring at least 12 months after the last menstrual period, in a woman who is of menopausal age. PMB is a common problem presenting in general practice, and accounts for 5% of secondary care referrals. Although PMB usually has a benign cause, it is important to exclude endometrial cancer, which is detected in approximately 10% of women presenting with PMB. This article offers an outline for the history, examination and initial investigations of PMB, as well as an overview of the common causes and how these are subsequently managed. The causes of postmenopausal bleeding (PMB) are listed in Box 1, however, by far the most common cause of PMB is vaginal atrophy related to the menopause. The menopause usually occurs between 45 and 55 years of age, however, the average age for women in the UK to reach the menopause is 51 years. After the menopause, oestrogen levels decrease causing the vaginal mucosa to become thinner, drier and more fragile. This can have a significant effect on a woman's sexual health, quality of life and can also contribute to urinary incontinence. Women are often reluctant to discuss such issues with medical professionals, but should be reassured that, although vaginal atrophy is a chronic, and often inconvenient, condition, there are plenty of effective and safe treatments available.
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