Post menopausal bleeding Flashcards
DDx of Post menopausal bleeding
Endometrial CA Cervical CA Endometrial Hyperplasia Atrophic Vaginitis Polyps of Cervix or endometrium Secondary to anticoagulation
Symptoms of atrophic vaginitis
Incontinence
Dysuria and urgency
Painful intercourse +/- light bleeding
genital itching
Complications of Atrophic vaginitis
Incontinence
UTI
Vaginal infections (thrush)
Risk factors for atrophic vaginitis
smoking
nulliparous
no sexual activity
Management of atrophic vaginitis
Vaginal moisturiser (2-3 days of efficacy)
Lubricant (water-based) during lubricant
Topical oestrogen (cream, pessary, vaginal ring)
Oral HRT
Causes of endometrial hyperplasia
Unopposed oestrogen Irregular menstrual bleeding (more unopposed oestrogen e.g. PCOS Obesity CA Long term tamoxifen therapy
Risk factors for endometrial hyperplasia
Obesity smoking over 35 years old nulliparous Early menarche/late menopause FHx ovarian/uterine/colon CA (HNPCC)
Symptoms of endometrial hyperplasia
menorrhagia
Short menstrual cycle (less than 21 days)
ANY post menstrual bleeding (ALWAYS ABNORMAL)
Dx of endometrial hyperplasia
TV Ultrasound
+/- hysteroscopy and biopsy/D&C
Management of endometrial hyperplasia
PROGESTERONE (oral, IM, IUD, vaginal cream)
(hyperplasia should regress in 6 months
If not or CA is suspected - Hysterectomy
Other Mx - weight loss decreases risk of endometrial CA
Symptoms of cervical CA
Usually asymptomatic in early stages
Bleeding (PMB/IMB/post coital bleeding/HMB)
Dyspareunia
Lower back pain
Risk factors for cervical CA
HPV
Smoking
? OCP (slight risk but reduces ovarian/endometrial CA risk)
Management of cervical CA
Surgery
- trachelectomy (cervix only) in fertile women +/- IVF
- hysterectomy (total or radical depending on stage
- chemo/radiotherapy
