What causes vaginal bleeding in a post menopausal patient?
Bleeding or spotting six to 12 months after periods have stopped is abnormal. Possible causes include polyps, use of unopposed estrogen, use of tamoxifen (a drug given during breast cancer treatment), thinning of the vagina, or – the most serious cause – cancer of the lining of the uterus. This endometrial cancer is the fourth most common cancer in women. All postmenopausal women with bleeding should have an endometrial biopsy to rule out cancer. Some physicians also use an ultrasound to evaluate the endometrial thickness. It is not enough to simply have a Pap smear, as this test may miss as many as 50 percent of all endometrial cancers. The best way to accurately diagnose endometrial cancer is to perform a D&C (a procedure that removes tissue from the lining of the uterus for testing), with or without a hysteroscopy (a procedure that involves inserting a small scope into the uterus so the doctor can visualize the lining).
