Makindo Medical Notes.com

Menopause is usually diagnosed in women over 45 who haven't had a period for more than a year. Any new bleeding from the vagina after this needs to be checked.

About

• Any Bleeding > 6 months after menopause
• Can be pink, spotting or brown discharge
• Can be seen in 20% of women

Concerns/Causes

• Cervical cancer
• Endometrial cancer: Around 10% of women with postmenopausal bleeding have endometrial cancer.1 In almost all of these cancer cases, bleeding is the first sign
• Endometrial Atrophy due to reduced levels of oestrogen
• Cervical Polyps usually nonmalignant and can be found in the lower uterus connecting to the cervix
• Atrophic vaginitis due to reduced levels of oestrogen
• Endometrial hyperplasia lining of the uterus becomes too thick, generally because of an accumulated amount of estrogen in the body with too little progesterone to counteract its effects due to HRT. Endometrial hyperplasia is considered a risk factor for endometrial cancer
• HRT may cause some light PV bleeding

Ask about

• Are they taking HRT
• Cramping or Abdominal Pain or Back or Pelvic pain
• Pain with sexual intercourse duration
• Fatigue, Sudden weight gain or loss
• Change in bowel movements, Constipation
• Fever and chills with ill feeling associated with infection

Investigations

• FBC, U&E, CRP
• Clotting screen
• Cervical smear
• TFTs
• Transvaginal USS, Endometrial biopsy
• Hysteroscopy and biopsy

Management

• Refer for urgent Gynaecological diagnostic assessment and work up at a special postmenopausal bleeding clinic for further tests. Exclude malignancy.
• Dilatation and Curettage (D&C): Under general anesthesia. It involves scraping the uterine lining to remove dysfunctional cells that lead to dysfunctional bleeding.
• Avoid using anti-coagulants and Aspirins to prevent bleeding as a side-effect.
• Anti-fibrinolytic therapy such as Tranexamic acid
• Avoid using tampons that can irritate the lining of the vagina. Use pads instead.