Post-Menopausal Bleeding

Question 1

What is post-menopausal bleeding?

Answer 1

Vaginal bleeding occurring at least 12 months after the last menstrual period.

Question 2

What must be excluded in post-menopausal bleeding and how common is it?

Answer 2

1. Endometrial carcinoma

2. 20% of post-menopausal bleeding

Question 3

What are the causes of post-menopausal bleeding?

Answer 3

1. Endometrial carcinoma/hyperplasia
2. Cervical carcinoma
3. Atrophic vaginitis (low oestrogen, diagnosis of exclusion)
4. Cervicitis
5. Ovarian carcinoma
6. Cervical polyps

Question 4

What is the investigation and management for post-menopausal bleeding?

Answer 4

1. Bimanual and speculum exam + cervical smear
2. TVUSS - thick endometrium (>4mm) or cavity filled with fluid suggests malignancy
3. Hysteroscopy and endometrial biopsy if >3mm thickness/multiple episodes of PMB