Postmenopausal Bleeding Flashcards
postmenopausal bleeding defintiion
any uterine bleeding in a postmenopausal person (1 year if no bleeding)
Those on cyclical HRT should still bleed
T/f
Those on cyclical HRT should still bleed
true.
Hormonal Uterine Bleeding
HRT is a popular treatment in menopause
Monthly bleeding would happen if taking cyclical HRT
___ bleeding is the most common cause of post menopausal bleeding. what is the ddx of this type of bleeding?
UTERINE BLEEDING.
Etiology; must consider vulvar, vaginal, cervical, uterus and fallopian tube causes
All can be a result of atrophy, dystrophy, infectious causes, vulvovaginitis, cancer, trauma, polyps, ectropion, dysplasia, etc.
Uterine bleeding is the most common cause of post menopausal bleeding.
Atrophy, polyps/fibroids, hormonal effects, cancer, pyometra or hematometra
Uterine Atrophy
Cause: hypoestrogenism causes atrophy of the ___ and ___. Within the endometrial cavity, friction can lead to chronic ____ and bleeding.
Symptoms: ___ vaginal tissue, loss of ___
Treatment:__
Uterine Atrophy
Cause: hypoestrogenism causes atrophy of the endometrium and vagina. Within the endometrial cavity, friction can lead to chronic endometritis and bleeding.
Symptoms: pale vaginal tissue, loss of rugae
Treatment: local estrogen
Uterine Polpys
Definition: benign ___ growths of unknown etiology, often in the context of ___ ___. Tissue becomes easily friable.
Treatment: __
Uterine Polpys
Definition: benign endometrial growths of unknown etiology, often in the context of microscopic inflammation. Tissue becomes easily friable.
Treatment: resection
Uterine Fibroids
Definition: ___ usually benign mass (besides leiomyosarcoma).
Quite rare of a cause of PMB because fibroids should regress without estrogen
Think of ___ if growing or symptomatic in the menopause
Treatment: manage with ___ resection or ____, medical management with ___
Uterine Fibroids
Definition: submucosal usually benign mass.
Quite rare of a cause of PMB because fibroids should regress without estrogen
Think of sarcoma if growing or symptomatic in the menopause
Treatment: manage with hysteroscopic resection or hysterectomy, medical management with GnRH antagonsists
Why are uterine fibroids often a RARE cause of POST menopausal bleeding?
fibroids should regress without estrogen. This is why we treat fibroids with GnRH agonists, where our body gets desensitized to the extra FSH and LH and stop producing as much estrogen.
___ is the first sign of endometrial cancer
bleeding is the first sign of endometrial cancer
what type of endometrial cnacer is most common?
endometrioid adenocarcinoma
key causes of endometrial cancer causing postmenopausal bleeding
Cause: unopposed estrogen, either exogenous (HRT, tamoxifen), or endogenous (peripheral fat)
Risk factors: unopposed estrogen, early menarche, infertility, obesity, diabetes, hypertension
-Tamoxifen acts as an anti-estrogen in breast tissue, but it acts like an estrogen in the uterus. In women who have gone through menopause, it can cause the uterine lining to grow, which increases the risk of endometrial cancer. The risk of developing endometrial cancer from tamoxifen is low (less than 1% per year).
Spectrum: abnormal pathology of endometrial cancer develops in a continuum
Simple hyperplasia, complex hyperplasia +/- atypia, carcinoma
invesitgations to post menopausal bleeding
Evaluate the lining: endovaginal U/S, endometrial biopsy, or dilation and curettage
Ultrasound: a lining of less than 5mm is considered normal. There is a 90% sensitivity.
Endometrial biopsy: 95% sensitivity, but a blind procedure. Painful, but it is gold standard
Dilation and Curettage: day surgery, local with sedation, can visualize cavity with hysteroscopy, and has a higher sensitivity (but both endometrial biopsy and DandC have over 90, so its better to just do endometrial biopsy.
- Describe common management strategies for postmenopausal bleeding due to endometrial cancer
Management is dependent on pathology, but includes:
Surgical staging
laparotomy/laparoscopy
Pelvic lymph node sampling
Prognosis:
Excellent, as 90% of endometrial cancers are diagnosed at stage 1 since abnormal bleeding is the first sign and women will get it checked out.
95% overall survival rate.
Adjuvant therapy could include radiation +/- chemotherapy
what is considered a thicker endometrium
>5mm
