7.6 -B- Post-menopausal bleeding Flashcards
What is post-menopausal bleeding?
Bleeding 12 months after last LMP
You are asked to take a history from a 53 year old patient presenting with a bleed. Her LMP was in 2021.
Give your differential diagnoses and take a focused history.
Tip: always go vulva, vagina, cervix, endometrium, tubes, ovary AND then Foetus (for obs) + Dont forget urine
Vulval cancer
Vaginal cancer
!!! Atrophic Vaginitis
Cervical malignancy
Cervical Polyps
!!!Endometrial hyperplasia
!!! Endometrial Cancer !!!! (10%)
!!! Endometrial polyps
Tubo-ovarian malignancy
UTI/acute kidney injury (mistaken from urine)
Hx:
Bleeding: Onset, quantify, frank/brown (worse or better?)
Post-coital bleeding
Gynae hx (LMP, Menarche)
Pain Socrates
Bloating
symptoms of anemia (chest pain, SOB, lethargy)
HRT
Medications: (Anticoagulants, Tamoxifen)
Fam and personal hx of colorectal, gynaecological malignancy, clotting problems?
What examinations will you perform for a patient with post-menopausal bleed and what are you looking for?
BMI (big risk factor)
Speculum: Cervical, vaginal, vulval carcinoma + Vaginal wall atrophy
Bimanual exam: Looking for adnexal masses, pelvic masses, and reduced mobility
Abdominal exam for masses
How would you retrieve a biopsy of a patient in OPD?
Pipelle biopsy involving a plastic straw that would have a syringe to create suction of cells to be sent to histology after being correctly labeled
What investigations will you perform on a patient presenting with post-menopausal bleeding?
1) Lab: FBC (anemia), coag screen (coagulopathy), Urinalysis/dipstick
Imaging: Transvaginal US for thickness of of 5cm or more (>4cm)
2) Pelvic US for large cysts and tumours
3) Biopsy: Pipelle or Hysteroscopy D&C (dilatation and curretage)
Management of post-menopausal bleeding involves treating the specific cause. In general, what would you offer to every patient?
Treat anemia with Fe,B12,folate
obviously if they have polyps or fibroids (very rare), remove them
