Postmenopausal Bleeding

Question 1

What are some causes of postmenopausal bleeding?

Answer 1

• Atrophic vaginitis (70%)
• Cancer (endometrial, cervical)
• Fibroids and polyps
• Endometrial hyperplasia
• Endogenous oestrogen

Less Common

• Prolapse
• Forgotten IUD
• Ovarian cause

Question 2

What questions can you ask to help differentiate the causes of postmenopausal bleeding?

Answer 2

?Last Period
?B symptoms
?HRT, other drugs 
?Abnormal vaginal discharge 
?Trauma

Question 3

How might you exam someone with postmenopausal bleeding?

Answer 3

Abdo exam - masses
Weight
Speculum - pap smear
Bimanual

Question 4

How do you investigate postmenopausal bleeding?

Answer 4

Transvaginal US
Ca-125 and CEA for ovarian diagnosis (CEA) and follow up (both)
Biopsy 
- Pappel
- Hysteroscopy - dilation and curettage