From the Guidelines
Postmenopausal or post-coital brown vaginal bleeding is most commonly caused by endometrial cancer, polyps, or endometrial hyperplasia, and less commonly by uterine fibroids, adenomyosis, or leiomyoma, as evidenced by the most recent study 1. The causes of postmenopausal or post-coital brown vaginal bleeding can be divided into structural and nonstructural etiologies.
Structural Causes
- Endometrial cancer is the most serious etiology and the main focus of evaluation in postmenopausal women with abnormal uterine bleeding, as stated in 1 and 1.
- Polyps and endometrial hyperplasia are also common structural causes of abnormal uterine bleeding in postmenopausal women, as mentioned in 1.
- Uterine fibroids, adenomyosis, and leiomyoma are less common causes of postmenopausal bleeding, but should still be considered, especially if there is persistent abnormal uterine bleeding or fibroid growth, as discussed in 1.
Nonstructural Causes
- Nonstructural causes, such as coagulopathies, ovulatory dysfunction, and primary endometrial disorders, are not typically associated with postmenopausal or post-coital brown vaginal bleeding, and are not discussed further in this context.
Diagnosis and Management
- The diagnostic workup for postmenopausal bleeding should include a thorough history, physical examination, and laboratory tests, as well as imaging studies such as endometrial biopsy, vaginal ultrasound, and hysteroscopy, as recommended in 1 and 1.
- Endometrial sampling is essential to rule out endometrial neoplasia and diagnose other conditions, as stated in 1.
- Treatment depends on the underlying cause and may include hormonal therapy, adjustment of birth control methods, or addressing specific conditions like fibroids or endometriosis, as discussed in the example answers. It is essential to note that the most recent study 1 provides the most up-to-date guidance on the management of uterine fibroids and postmenopausal bleeding, and should be prioritized in clinical decision-making.
From the Research
Causes of Abnormal Uterine Bleeding
The causes of abnormal uterine bleeding can be classified into two main categories: structural and non-structural etiologies.
- Structural etiologies include:
- Polyps
- Adenomyosis
- Leiomyoma (fibroids)
- Malignancy and hyperplasia
- Non-structural etiologies include:
- Coagulopathy
- Ovulatory dysfunction
- Endometrial causes
- Iatrogenic causes
- Not otherwise classified
Specific Causes of Postmenopausal or Post-Coital Brown Vaginal Bleeding
There are no specific research papers provided to directly answer the question about the causes of postmenopausal or post-coital brown vaginal bleeding. However, the provided studies discuss the causes of abnormal uterine bleeding in general, which may be relevant to understanding the potential causes of postmenopausal or post-coital bleeding 2, 3, 4, 5.
Related Conditions
Some studies mention conditions that may be related to abnormal uterine bleeding, such as:
- Fibroids, which can cause heavy menstrual bleeding 6
- Endometriosis, which can cause cyclical pelvic pain 6
- Ovarian cysts, which are generally diagnosed incidentally 6
- Thyroid dysfunction, which can cause abnormal uterine bleeding 2, 4
- Coagulation disorders, such as von Willebrand disease, which can cause heavy menstrual bleeding 2, 3, 4, 5