Sep 20, 2026 · 9 min · 6 segments
Listen in to GODU's first episode as we explore **postmenopausal bleeding**: its incidence, aetiology, workup, and management. For helpful resources, check out: - GACGP: The woman with…
Today's topic is postmenopausal bleeding.
This is commonly seen by gynaecologists, but also emergency and general practitioners.
Postmenopausal vaginal bleeding occurs in about 10% of women in Australia and Aotearoa, New Zealand.
The incidence reduces with increased time since menopause.
But Maddy, what actually is postmenopausal bleeding?
Okay, we define postmenopausal bleeding as bleeding after menopause has established.
So after 12 months of amenorrhea.
Sometimes this results in people mistakenly attributing vaginal bleeding as return of menses.
Also, sometimes bleeding from the urinary tract or rectal bleeding can be misdiagnosed as vaginal bleeding, which is a specific symptom that we actually want to investigate.
The most common reasons for bleeding are benign, vaginal or endometrial atrophy, which accounts for one to two thirds of all cases and can be treated with local estrogen most of the time.
But despite this, it's well established that postmenopausal bleeding always warrants further investigation.
That's right.
As you've said, there are many benign reasons for postmenopausal bleeding and these can be easily treated.
Fibroids or polyps can be excised.
Infections can be treated with antibiotics.
Foreign bodies can be removed.
Sometimes medications such as anticoagulation or menopausal hormone therapy need to be adjusted and reviewed if they are contributing to the symptoms.
But the key differential and the reason that these patients are referred to gynaecologists is because of genital tract pre-malignancies and malignancies.
in particular, endometrial hyperplasia and cancer.
And because that risk of cancer is about 10%, we have to make sure we have thoroughly worked up all cases.
Today's topic is postmenopausal bleeding.
This is commonly seen by gynaecologists, but also emergency and general practitioners.
Postmenopausal vaginal bleeding occurs in about 10% of women in Australia and Aotearoa, New Zealand.
The incidence reduces with increased time since menopause.
But Maddy, what actually is postmenopausal bleeding?
Okay, we define postmenopausal bleeding as bleeding after menopause has established.
So after 12 months of amenorrhea.
Sometimes this results in people mistakenly attributing vaginal bleeding as return of menses.
Also, sometimes bleeding from the urinary tract or rectal bleeding can be misdiagnosed as vaginal bleeding, which is a specific symptom that we actually want to investigate.
The most common reasons for bleeding are benign, vaginal or endometrial atrophy, which accounts for one to two thirds of all cases and can be treated with local estrogen most of the time.
But despite this, it's well established that postmenopausal bleeding always warrants further investigation.
That's right.
As you've said, there are many benign reasons for postmenopausal bleeding and these can be easily treated.
Fibroids or polyps can be excised.
Infections can be treated with antibiotics.
Foreign bodies can be removed.
Sometimes medications such as anticoagulation or menopausal hormone therapy need to be adjusted and reviewed if they are contributing to the symptoms.
But the key differential and the reason that these patients are referred to gynaecologists is because of genital tract pre-malignancies and malignancies.
in particular, endometrial hyperplasia and cancer.
And because that risk of cancer is about 10%, we have to make sure we have thoroughly worked up all cases.
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