Menstruation at Age 58: Not Normal – Causes and Required Evaluation

Menopause (12 consecutive months without menses) typically occurs at 45–55 (average 51). Bleeding after age 55 is postmenopausal bleeding (PMB) and always warrants investigation.

Common Causes of PMB

• Atrophic endometritis/vaginitis: Hypoestrogenic thinning → friable mucosa, spotting.
• Endometrial polyps: Benign focal overgrowths.
• Endometrial hyperplasia: Unopposed estrogen → abnormal thickening; may be atypical (premalignant).
• Endometrial carcinoma: Most concerning; ~10% of PMB cases. Peak incidence 60–70.
• Hormone therapy: Sequential or continuous combined regimens can cause scheduled or unscheduled bleeding.
• Anticoagulants, tamoxifen.
• Cervical/vaginal pathology: Polyps, cancer, atrophy.

Diagnostic Workup

1. Transvaginal ultrasound: endometrial thickness >4 mm → biopsy indicated.
2. Endometrial sampling (Pipelle, hysteroscopy with D&C).
3. Cervical cytology/HPV if cervical source suspected.

Action

Any bleeding >12 months after last period → see gynecologist promptly. Early detection of endometrial cancer has excellent prognosis (5-yr survival >90% for stage I).