Post-menopausal bleeding

Question 1

What is post-menopausal bleeding?

Answer 1

1) It is bleeding from the female genital tract in the appropriate aged woman
- not using HRT
- at least 6 months after cessation of menstruation

2) Bleeding from the female genital tract that occurs when the woman is on HRT but is a cyclic in nature

Question 2

What are the causes of PMB?

Answer 2

1. Systemic
2. Uterine
3. Cervix
4. Vaginal
5. Bladder
6. Bowel

Question 3

What are the systemic causes of bleeding?

Answer 3

1. Anticoagulants-warfarin
2. Thromobocytopenia, von willebrand disease
3. Oestrogens-HRT, phytooestrogens

Question 4

What are the uterine causes of bleeding?

Answer 4

Benign:

• polyps
• fibroids
• adenomyosis
• emndometritis

Malignant:

• endometrial hyperplasia
• endometrial ca
• sarcoma

Question 5

What are the cervical causes of bleeding?

Answer 5

• Cervical ca
• cervicitis
• post-coital

Question 6

What are the vaginal causes of bleeding?

Answer 6

1. Atrophy-secondary to decreased oestrogen levels
2. Vaginitis
3. Malignancy
4. Trauma
5. Post-coital

Question 7

What are the bladder causes of bleeding?

Answer 7

Bladder ca
Bladder stone
Cystitis

Question 8

What are the bowel causes of bleeding?

Answer 8

Colorectal ca

Local pathology

Question 9

What is the approach to the management of a patient with PMB?

Answer 9

1. History(detailed)
Is it post-coital
Nature of bleeding
Gynaecology Hx
-When menopause started, menarche, papsmears

2. Examination
   - general, vitals,
   - abdomen, rectal exam NB
3. Special examinations
   - speculum exam-cervical ca
   - bimanual exam-looking for pain/masses
   - transvaginal exam-if more than 5mm take biopsy
   - Pipelle(endometrial biopsy)
   - hysteroscopy
   - saline infusion sonography