Post menopausal bleeding Flashcards
1
Q
Post menopausal bleeding:
Definition?
A
• any bleeding at least 12 months post last NORMAL menses
OR
• more than 6 months after starting MHT
2
Q
Post menopausal bleeding:
Causes?
A
- Atrophy 60%
- Exogenous oestrogen 15 – 25%
- Polyps 2 – 12%
- Endometrial cancer 10%
- Other malignancy 1%
3
Q
Post menopausal bleeding:
Approach?
A
Need to know:
a) Risk factors for Endometrial carcinoma
b) Tamoxifen exposure
c) CST status/history
4
Q
Post menopausal bleeding:
Risk Factors for endometrial carcinoma?
A
- tamoxifen exposure
- family history of endometrial carcinoma or colorectal cancer (Lynch Syndrome)
- Nulliparity
- Obesity
- chronic anovulation/PCOS
- 6 months of unsuccessful conservative management
- unopposed oestrogen supplementation
5
Q
Post menopausal bleeding:
Investigations and management?
A
Investigate/refer:
a) Tamoxifen = TV USS (with Endometrial thickness (ET)) AND immediate referral
b) Everyone else gets TV USS (with ET)
≤4mm ET AND no risk factors for Endometrial Carcinoma = GP follow up **if any further PMB = referral
> 4mm ET = referral
