Post-Menopausal Bleeding

• 10-15% chance that this could be a cancer
• R/O before treating anything (e.g. vaginal driness)

Etiology

• Pre-menopausal (AUB) - PALM COEIN
• Post-menopausal - Benign vs Malignant

  • Benign

    • GSM - Genitourinary Syndrome of Menopause is the most common cause
    • Uterine Polps (can have hypertrophy and dysplasia in polyp - remove if > 11 cm)
    • cyclic HRT would bring on bleeding too

  • Malignant

    • Hyplerplasia + atypia = indication for hysterectomy
    • Endometrial Cancer (10-15%)
    • Ovarian cancer , Vaginal, non-GU causes

  • Endometriosis doesn’t cause irregular bleeding except Dysmenorrhea

  • *Fibroid also don’t cause PMB

Presentation

Investigation

• • Post-menopausal bleeding → MUST R/O Endometrial Cancer
• NEED Endometrial biopsy
• Pelvic US
  • CT is bad at looking at pelvic organ
  • MRI if US is not good
  • • EVEN with a normal US (thin lining), you still NEED endometrial biopsy
  • Normal → in-office biopsy
  • Abnormal (mass/polyp) → Hysteroscopy + biopsy

Management

Risk Factors

Protective Factors

Work-up