All are causes of postmenopausal bleeding except :
**Core Concept**
Postmenopausal bleeding refers to vaginal bleeding that occurs after a woman has experienced menopause, typically defined as the cessation of menstrual periods for 12 consecutive months. The causes of postmenopausal bleeding can be broadly categorized into malignant, non-malignant, and non-gynecologic etiologies.
**Why the Correct Answer is Right**
Postmenopausal bleeding can be caused by a variety of factors, including endometrial hyperplasia, endometrial cancer, cervical cancer, ovarian cancer, pelvic inflammatory disease, and thyroid disorders. The presence of estrogen can stimulate the growth of the endometrium, leading to hyperplasia and potentially cancer. Additionally, atrophy of the vaginal and urethral mucosa can lead to bleeding due to thinning of the tissues.
**Why Each Wrong Option is Incorrect**
**Option A:** Endometrial hyperplasia is a known cause of postmenopausal bleeding, often associated with unopposed estrogen exposure.
**Option B:** Cervical cancer can also cause postmenopausal bleeding, often presenting with abnormal vaginal discharge or bleeding.
**Option C:** Ovarian cancer can cause postmenopausal bleeding, although it is less common than other gynecologic malignancies.
**Clinical Pearl / High-Yield Fact**
A key point to remember is that postmenopausal bleeding should always be investigated promptly, as it may be the first presenting symptom of a malignancy.
**Correct Answer:** D.