Post-menopausal bleeding

1
Post-menopausal bleeding

• Definition
• Any vaginal bleeding after a period of
  amenorrhoea of 6 months or more in the
  perimenopausal age group
• Menstruation after age 55 years
• Vaginal bleeding in the presence of raised FSH
  and LH values in perimenopausal age group

2
Aetiology danger table

• Carcinomas (Cx, endometrium, sarcomas)
• Submucous fibroids
• Endometrial polyps
• Oestrogen therapy
• Bleeding from bladder or rectum
• Trauma
• Atrophic endometritis

3
Aetiology frequency table

• Atrophic endometritis 40-45
• Malignancies 25
• Endometrial carcinoma
• Cervical carcinoma
• Uterine sarcomas
• Endometrial hyperplasia
• Polyps and fibroids 10-15
• Hormone therapy 25
• Other disorders 10

4
Approach to patient with PMB

• History
• Full, of bleeding, medication, trauma,
  climacteric complaints, medical status,
  operations
• Examination
• General and systemic, abdomen
• Note obesity, diabetes, anemia, hypertension
• Gynaecologic inspection, speculum, e/e smear,
  bimanual examination

5
Special tests

• Endometrial thickness measurement on ultrasound
• Side-to-side 4mm or less 97 chance for atrophy
• Endometrial sampling
• Outpatient procedure, small vacuum pipettes
• DC and hysteroscopy
• If not possible to do sampling in office

6
Management

• Treat the cause
• Atrophy topical or systemic oestrogens
• Polyps or fibroids usually hysterectomy
• Hyperplasia P Rx or hysterectomy
• Malignancies treat as for specific type
• Follow-up