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BACKGROUND: Human leech infestation is a disease of the poor who live in rural areas and use watercontaminated with leeches. Like any other body orifices, vagina can also be infested by leech whenfemales use contaminated water for bathing and/or douching. Although this condition is very rare inpostmenopausal women, it causes morbidities and mortalities.CASE DETAILS: A 70 year old Para X (all alive) abortion I mother, postmenopausal for the last 20years, presented with vaginal bleeding of 3 weeks duration to Gimbie Adventist Hospital, WesternEthiopia. On examination, she had deranged vital signs and there was a dark moving worm attached tothe cervical os. She was admitted with the diagnosis of hypovolumic shock and severe anemia secondaryto postmenopausal vaginal bleeding. After the patient was stabilized with intravenous crystalloids, theleech was removed from the vagina. She was then transfused with two units of whole blood anddischarged with good condition on the 3 rd post procedure day with ferrous sulphate.CONCLUSION: Vaginal leech infestation in postmenopausal woman can cause hypovolumic shock andsevere anemia. Therefore, in order to decrease morbidities from failure or delay in making the diagnosis,health care providers should consider the possibility of vaginal leech infestation in postmenopausalwoman from rural areas and those who use river water for drinking, bathing and/or douching andpresented with vaginal bleeding. In addition, the importance of using clean water and improving accessto safe water should be emphasized.