Post-menopausal bleeding

Question 1

Define post-menopausal bleeding

Answer 1

• Vagina bleeding after 12 months of amenorrhoea
• Needs to be in woman of age where menopause is expected

PMB TREATED AS MALIGNANCY UNTIL PROVEN OTHERWISE

Question 2

What are the causes of post-menopausal bleeding?

Answer 2

BENIGN DISEASE
Vaginal atrophy*
Endometrial hyperplasia/polyps

MALIGNANT DISEASE

• Endometrial, cervical, vulva, ovarian
• Uterine sarcoma

DRUGS

• HRT
• Tamoxifen increases risk of endometrial caricnoma

OTHER

• Trauma
• Bleeding disorder

Question 3

How is PMB treated?

Answer 3

MUST have 2 week referral to gynaecologist

1. Transvaginal ultrasound scan

IF HIGH CLINICAL SUSPICION OF CANCER ==>

2. Hysteroscopy with endometrial biopsy