Post menopausal bleeding Flashcards
What can be classed as PMB?
Vaginal bleeding after >12 months amenorrhoea in women at the age where the menopause can be expected
What are some common causes of PMB?
Vaginal atrophy HRT Endometrial hyperplasia Endometrial cancer Cervical cancer Ovarian cancer
What are some less common causes of PMB?
Vaginal cancer
Vulval cancer
Trauma
Bleeding disorders
What is PMB a red flag for investigation of?
Endometrial cancer
What is the most common cause of PMB?
Vaginal atrophy
What is vaginal atrophy?
Thinning, drying and inflammation of wall of vaginal due to reduced oestrogen
How is vaginal atrophy managed?
Topical oestrogens
Lubricants
HRT
What is endometrial hyperplasia?
Abnormal thickening of endometrium
Precursor to canecr
What are the risk factors for endometrial hyperplasia?
Obesity PCOS Diabetes Unopposed oestrogen use Tamoxifen
What is the management of endometrial hyperplasia?
No atypia= High dose progestogens
Dilatation and curettage
Atypia= Hysterectomy
What is the cardinal symptom of endometrial cancer?
PMB
~10% of those with PMB will have endometrial cancer
What are the risk factors for endometrial cancer?
Obesity Early menarche, late menipause Nulliparity Unopposed oestrogen Diabetes PCOS Tamoxifen
What investigations are done for endometrial cancer?
Transvaginal US within 2 weeks of PMB
Hysteroscopy with biopsy
What is the management of endometrial cancer?
TAH BSO
What investigations should be done for PMB?
Transvaginal US within 2 weeks
Vaginal and abdo exam
Urine dipstick
FBC, CA 125
