Post Menopausal Bleeding (PMB)

Last updated 20.09.12

 

Definition

-  Episode of vaginal bleeding 12+ months after the last period (menopause)

-  For women undergoing Hormone Replacement Therapy (HRT)

-  Sequential therapy: heavy or prolonged at the end of or after the progestogen phase or breakthrough bleeds

-  Combined therapy: occurs after 6 months Rx or after amenorrhoea has been established

 

Features

-  20-30% women

 

Hx

-  Meds

-  Anticoagulants

-  Tamoxifen

-  HRT

-  Trauma

-  Family Hx: Lynch syndrome (HNPCC)

-  DM, HTN, hyper-oestrogenis

 

Exam

-  Abdo exam: masses

-  Speculum: genital atrophy, cervical polyps

-  +/- Pap smear

-  Bimanual exam

-  Obesity

 

Causes

-  Atrophy of vagina or uterus 60-80%

-  Ca

-  Cervical, vaginal

-  Endometrial Ca 10% pts

-  Uterine hyperplasia 5-10%

-  Hormone therapy (HRT) or other oestrogens 15-25%

-  Uterine or cervical polyps 2-12%

 

Ix

-  Pipelle endometrial aspiration (biopsy)

-  Abnormal histology --> Hysteroscopy D&C

-  Normal histology + > 4mm endometrial thickness --> Hysteroscopy D&C

-  If >10mm risk of malignancy 10-20%

-  Normal histology + < 4mm endometrial thickness --> no action required

-  Risk of malignancy <0.5%

-  TV ultrasound: endometrial thickness (controversial)

-  +/- Hysteroscopy D&C

 

Mx

 

 

Diagram

 

 

 

 

References