Differential Diagnosis for Postmenopausal Spotting

Single Most Likely Diagnosis

• Atrophic Vaginitis: This condition is the most common cause of postmenopausal bleeding, resulting from the thinning and drying of the vaginal walls due to decreased estrogen levels. It is characterized by symptoms such as vaginal dryness, itching, and pain, in addition to spotting.

Other Likely Diagnoses

• Hormone Replacement Therapy (HRT): Women on HRT may experience breakthrough bleeding or spotting due to the hormonal changes induced by the therapy.
• Endometrial Polyps: These are growths in the lining of the uterus that can cause irregular bleeding, including spotting, in postmenopausal women.
• Endometrial Hyperplasia: A condition where the lining of the uterus grows too thick, which can lead to irregular vaginal bleeding.

Do Not Miss Diagnoses

• Endometrial Cancer: Although less common, endometrial cancer is a critical diagnosis to consider in postmenopausal women with vaginal bleeding, as it can present with spotting or more significant bleeding.
• Cervical Cancer: Another important diagnosis not to miss, as it can also present with abnormal vaginal bleeding in postmenopausal women.

Rare Diagnoses

• Uterine Sarcoma: A rare type of cancer that begins in the muscle and supporting tissues of the uterine walls, which can cause abnormal bleeding.
• Vaginal Cancer: A rare type of cancer that can cause bleeding, including spotting, in postmenopausal women.
• Ovarian Cancer: Although primarily associated with other symptoms, ovarian cancer can occasionally present with abnormal vaginal bleeding in postmenopausal women.