| Summary: | Background: Caesarean scar defect (CSD) is a complication of caesarean section with implications for abnormal uterine bleeding. Most cases of CSD are discovered incidentally or with the development of menstrual changes. However, CSD may rarely have a longer latency period, resulting in postmenopausal presentation of bleeding and abdominal pain. Case: A 52-year-old postmenopausal woman presented with acute suprapubic pain and postmenopausal bleeding. Pelvic ultrasonography and magnetic resonance imaging suggested bleeding from a CSD. Her symptoms resolved with expectant management. She subsequently underwent elective hysterectomy and bilateral salpingo-oophorectomy, which provided histological confirmation of a CSD. Conclusion: Caesarean scar defect should be considered in patients who present with acute abnormal uterine bleeding or pelvic pain with a history of caesarean section, even after menopause.
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