Post-menopausal bleeding Flashcards
What is postmenopausal bleeding?
Vaginal bleeding occurring after twelve months of amenorrhoea
What age of women does postmenopausal bleeding occur in?
The age where menopause can be expected
Who can postmenopausal bleeding occur in?
Women at the age that menopause can be expected
In younger women who have experienced premature ovarian failure or menopause
What percentage of people with endometrial cancer present with postmenopausal bleeding?
About 90%
What can postmenopausal bleeding suggest?
Endometrial malignancy
What is the most common cause of postmenopausal bleeding?
Vaginal atrophy
What is vaginal atrophy?
Thinning, drying, and inflammation of the vagina walls
What is vaginal atrophy due to?
Reduction in oestrogen
How can vaginal atrophy present?
Pruritus
Dyspareunia (Pain during sex)
Vaginal discharge
What is commonly seen with HRT?
Breakthrough bleeding for the first 6 months
What is endometrial hyperplasia?
Abnormal thickening of the endometrium
What other investigations would you carry out for postmenopausal bleeding?
Thorough history
Vaginal and full abdominal examination
What is endometrial hyperplasia a precursor for?
Endometrial carcinoma
What is the most concerning diagnosis of postmenopausal bleeding?
Endometrial carcinoma
What is the main investigation for someone with postmenopausal bleeding?
Transvaginal ultrasound
When would a woman be referred for a transvaginal ultrasound within 2 weeks?
If they were over 55 and had postmenopausal bleeding
What are the possible causes of postmenopausal bleeding?
Vaginal atrophy
HRT
Endometrial hyperplasia
Endometrial carcinoma
What is the management of postmenopausal bleeding dependent on?
The diagnosis
What is the management of vaginal atrophy?
Topical oestrogens
Lubrication
What is the management of endometrial hyperplasia?
Dilatation and curettage to remove excess endometrial tissue
