Post-menopausal Bleeding Flashcards
What is the definition of post-menopausal bleeding?
Vaginal bleeding occurring after 12 months of amenorrhoea at an age where menopause is to be expected
When can post-menopausal bleeding be applied to younger women?
When the woman has premature ovarian insufficiency or premature menopause
What is unscheduled bleeding?
Non-cyclical bleeding still occurring 6 months after commencing HRT or after 6 months of amenorrhoea
What are the possible causes of post-menopausal bleeding?
- Vaginal atrophy
- Use of HRT
- Endometrial hyperplasia
- Endometrial cancer
- Endometrial or cervical polyps
- Cervical, ovarian, vaginal or vulval cancer
- Non-gynaecological causes
What is the most common cause of post-menopausal bleeding?
Vaginal atrophy
What are the possible non-gynaecological causes of post-menopausal bleeding?
- Trauma
- Bleeding disorders
How should post-menopausal bleeding be treated until proven otherwise?
As malignant in nature
What is the first management step for any post-menopausal bleeding?
Appointment with gynaecologist within 2 weeks
What is the first line investigation in post-menopausal bleeding?
Transvaginal USS
What does transvaginal USS in post-menopausal bleeding help to identify?
Women at risk of endometrial cancer (and endometrial hyperplasia)
How does thickness of endometrium in post-menopausal women relate to the likelihood of serious pathology?
Thicker = more likely
What is the threshold for further investigation of endometrial thickness in the UK?
5mm (but I’ve also seen 3 in the notes and Peterborough said 4 so idk)
How is a definitive diagnosis of the cause of post-menopausal bleeding made?
Histology of biopsy
How are most endometrial biopsies obtained?
Pipelle method
What method of obtaining biopsies is preferred for endometrial polyps an other benign lesions?
Hysteroscopy and curretage
