The term post menopause is applied to women who have not

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 include vasomotor symptoms such as hot flashes and palpitations, psychological effects such as depression, anxiety, irritability, mood swings, memory problems and lack of concentration, and atrophic effects such as vaginal dryness and urgency of urination
 The term post menopause is applied to women who have not experienced a menstrual bleed for a minimum of 12 months, assuming that they do still have a uterus, and are not pregnant or lactating because the ovaries become inactive  the most typical age range for menopause is 51 years  postmenopause is identified by a very high FSH level.
 Postmenopausal bleeding is more likely to be caused by pathologic disease than the bleeding in younger women, and it must always be investigated
Example from the GIT or urinary system.
- Long term oestrogen/progesterone HRT is some time is recommended for prevention of osteoporosis to improve life quality. -.
- Examination reveal thin tissue with ecchymosis - With vulvar dystrophy there may be a white area and cracking of the skin of the vulva.
Found in about 15% of cases of PMB - Endometrial polyps. Occur in up to 10% of women with PMB - Endometrial carcinoma, may be present in 7-10% of women with PMB.
May present with PMB often with an offensive blood stained discharge. › Vulva tumors, the majority of vulvusually develop from precancerous , pre-invasive areas called vulvar intraepithelial neoplasia (VIN) › Uterine sarcoma or even tubal carcinoma and ovarian carcinoma especially oestrogen secretory ovarian tumors, are other rare causes of PMB.
In most cases endometrial sampling will be required. › An initial examination looking for signs of systemic diseases is extremely important. › Pelvic examination include an evaluation of the oestrogenic state of the vagina and cervix. Characteristic finding include a pale and thin appearance of the vaginal mucosa.
› High vaginal swabs should be taken if discharge is present. › The use of U/S as an initial step at investigation has some advantages. It is less invasive, sensitive, cheaper and allows visualization of other pelvic organs..
Particularly useful in older patients who are less likely to tolerate more invasive investigations like D/C(curettage) › However, those patients who have persistent bleeding or have a detectable abnormality on ultrasound require endometrial sampling (curettage).
› Treatment will be directed at the underlying aetiology..
 In case of endometrium polyp should be removed by hysteroscopy after a normal histopathology befor  In case of vagina or vulva atrophy, should treat it with local oestrogen ( vaginal cream or vagitorium)  In case of exogenous hormons, try to change or stop the HRT pills  In case of cancer, according to the type of it (surgical / radiotherapy /chemotherapy)
 Management depends on the causes.