Post menopausal bleeding

Continues absence of menstruation for 1 year is called as menopause.

Bleeding after menaupose is postmenapausal bleeding.

Aetiology

·        Vulva /vagina- trauma, localized infection ,tumors 9benign /malignancies)

·        Cervix – cervicitis , polyp ,decubitus ulcer in prolapse,malignancy

·        Uterus- senile endometritis ,endometrial hypeplasia , endometrial polyp,endometrial               malignancy

·        Fallopian tube malignancies

·        Esrogen secreting ovarian malignancies

·        Prolonged use of estrogen unopposed by progesterone in HRT

History and examination

Age of menarche and menopause

History of taking oestrogen and tamoxifen

History of prolapse

Abdominal pain

Foul smelling discharge

Urinary and rectal symptoms .

Speculum examination – look for vulval ,vaginal and cervical causes

Abdominal and bimanual examination- abdominal tumor

Investigation

Excluding malignancy is the main aim of investigation.

1.     Transvaginal ultrasound – measure the  endometrial thickness

                                               If ET >4mm need endometrial biopsy

2.     Endometrial biopsy

3.     Cervical smear and biopsy if cervical pathology is suspected

Treatment

Treat the cause

If no cause is found and only one episode of  bleeding , noo intervention is needed.

If bleeding persist may need hysterectomy and histopathological study of the specimen.