[34] Post-menopausal Bleeding Flashcards

1
Q

What is the definition of post-menopausal bleeding?

A

Vaginal bleeding occurring after 12 months of amenorrhoea at an age where menopause is to be expected

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2
Q

When can post-menopausal bleeding be applied to younger women?

A

When the woman has premature ovarian insufficiency or premature menopause

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3
Q

What is unscheduled bleeding?

A

Non-cyclical bleeding still occurring 6 months after commencing HRT or after 6 months of amenorrhoea

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4
Q

What are the possible causes of post-menopausal bleeding?

A
  • Vaginal atrophy
  • Use of HRT
  • Endometrial hyperplasia
  • Endometrial cancer
  • Endometrial or cervical polyps
  • Cervical, ovarian, vaginal or vulval cancer
  • Non-gynaecological causes
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5
Q

What is the most common cause of post-menopausal bleeding?

A

Vaginal atrophy

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6
Q

What are the possible non-gynaecological causes of post-menopausal bleeding?

A
  • Trauma

- Bleeding disorders

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7
Q

How should post-menopausal bleeding be treated until proven otherwise?

A

As malignant in nature

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8
Q

What is the first management step for any post-menopausal bleeding?

A

Appointment with gynaecologist within 2 weeks

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9
Q

What is the first line investigation in post-menopausal bleeding?

A

Transvaginal USS

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10
Q

What does transvaginal USS in post-menopausal bleeding help to identify?

A

Women at risk of endometrial cancer (and endometrial hyperplasia)

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11
Q

How does thickness of endometrium in post-menopausal women relate to the likelihood of serious pathology?

A

Thicker = more likely

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12
Q

What is the threshold for further investigation of endometrial thickness in the UK?

A

5mm (but I’ve also seen 3 in the notes and Peterborough said 4 so idk)

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13
Q

How is a definitive diagnosis of the cause of post-menopausal bleeding made?

A

Histology of biopsy

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14
Q

How are most endometrial biopsies obtained?

A

Pipelle method

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15
Q

What method of obtaining biopsies is preferred for endometrial polyps an other benign lesions?

A

Hysteroscopy and curretage

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16
Q

How can cervical polyps be treated?

A

Removal

17
Q

How can endometrial atrophy be treated?

A

Oestrogen cream or pessaries

18
Q

How can HRT related post-menopausal bleeding be stopped?

A

By stopping or changing HRT