Post Menopausal Vaginal Bleeding (PMB) can’t be ignored irrespective of it’s severity.  The most common causes are inflammation and thinning of the vaginal lining (atrophic vaginitis) or womb lining (endometrial atrophy) – caused by lower estrogen levels, cervical or womb polyps – growths that are usually non-cancerous and rarely carcinoma endometrium. In about 10% of women, bleeding after menopause is a sign of uterine cancer.

This is a case of 62 year old lady who presented with complaint of per vaginal spotting.  she was one of my relative so I told her to get an immediate gynecologic consultation, so she went back and consulted a gynecologist but all clinical examination by then became normal there was healthy cervix, vagina and nothing pathological palpable on per abdominal examination.

This was followed by USG abdomen which came out normal! Year after,  patient had another episode of vaginal bleeding. This time things were not as inconspicuous & innocent as before. This time in USG thickness of endometrium was significant which was in reflex followed by MRI which showed diffuse thickness of endometrium with maximum thickness of 2.5 cm. There was  heterogeneous focal enhancements and diffuse restriction with focal restrictions in myometrium. Possibility of endometrial carcinoma was suggested. 

For subtyping of it, radical hysterectomy was performed which was then followed by histopathological examination. To our surprise histopathology report revealed carcinoma of endometrium!!!

Carcinoma of endometrium is an endometrial stromal tumor which is very aggressive in its course and difficult to catch on USG in its initial phase! So it can be missed there!

By the time it get caught, it may get metastasize to other places in body. By your sincerity if you can catch it in critical time it can be taken out from your body with extensive dissection of nearby lymph node. Which could be followed by courses of chemotherapy and by radiotherapy if needed.

Causes of postmenopausal vaginal bleeding (PMB)

• Polyp (37.7 percent)
• Hypotrophy/atrophy (30.8 percent)
• Proliferative/secretory (14.5 percent)
• Carcinoma (6.6 percent)
• Fibroid (6.2 percent)
• Hyperplasia witho