Post menopausal bleeding

Question 1

What are the causes of PMB?

Answer 1

Common: genital tract atrophy, endometrial polyps, fibroids, side effect of HRT (in first 6 months)
Important to rule out malignancy: endometrial cancer, cervical cancer

Question 2

What are the Ix for PMB?

Answer 2

All women with PMB should have a TV pelvic U/S assess endometrial thickness (<4mm)
An ET >4mm should Ix with a hysteroscopy and endometrial sample

Question 3

What is the management of PMB?

Answer 3

PMB usually ceases without treatment and therefore the main aim is to exclude malignancy
Genital atrophy is a common cause of PMB and therefore in women where no other cause for the PMB is found, vaginal oestrogen may be used
PMB due to endometrial polyps should resolve once a polypectomy has been performed
Hysteroscopic resection for submucosal fibroids
Mx malignancy as indicated
Recurrent PMB which does not improve with oestrogen treatment suggests an abnormality and may need to be treated with a hysterectomy