-
what is menopause?
permanent cessation of menstruation resulting from loss of ovarian follicular activity
-
when can menopause be diagnosed?
after 12 consecutive months of amenorrhoea
-
what is post menopausal bleeding?
vaginal bleeding occurring at least 12 months after the last menstrual period
-
when is PMB normal?
if on combined cyclical HRT, bleeding in the progesterone free period is normal
-
what is the cause of PMB in most cases?
atropic vaginitis where vaginal epithelium thins and breaks down in response to low oestrogen levels
-
what 4 things do you want to exclude if pt presents with PMB?
- 1. endometrial carcinoma
- 2. cervical carcinoma
- 3. pre-malignant endometrial hyperplasia with cytological atypia
- 4. ovarian carcinoma
-
what are the non-cancerous causes of PMB?
- 1. atrophic vaginitis: poorly oestrogenised vaginal wall
- 2. cervicitis
- 3. cervical polyp
- 4. endometrial polyp
- 5. withdrawal bleed from HRT
- 6. foreign body eg pessary
-
what Qs need to be asked in history of PMB?
- 1. bleeding: when, frequency, quantity, how many pads, consistency - clots or spotting, colour
- 2. trauma: post coital, insertion of pessary or tampon
- 3. smear
- 4. obs: gravida and parity
- 5. PMH: diabetes, PCOS, obesity (increase risk of PMB)
- 6, pain?
-
what are the risk factors of endometrial cancer?
- 1. obesity
- 2. HRT
- 3. nulliparity
- 4. PCOS
- 5. tamoxifen
- 6. HNPCC gene
- 7. diabetes
-
what examinations need to be done in PMB?
- 1. abdominal: mass, tender, fluid
- 2. speculum cuscos: vulval lesions or trauma, look at vagina and cervix for tears, polyps, ulcers, cancer, inflammation, atrophic vaginitis, discharge,
- 3. take swabs as BV common
- 4. look for foreign bodies eg ring pessary
- 5. bimanual examination
- 6. smear test
- 7. pipelle biopsy
-
what will atrophic vaginitis look like on examination?
- 1. pale
- 2. thin
- 3. flattened, no rugae
-
what do you look for on bimanual examination?
- 1. vulva labia, varicose veins, lacerations, trauma, warts
- 2. introitus
- 3. vaginal walls
- 4. cervix: position, length, consistency, excitation
- 5. uterus: position, size, mobile,
- 6. adnexal masses
- TENDERNESS anywhere
-
what investigations are needed in PMB?
- 1. ultrasound ALL women with PMB: transvaginal US. check size of uterus, endometrial thickness and adnexal masses.
- 2. hysteroscopy and endometrial biopsy if on tamoxigen or >5mm or recurrent PMB
-
what is normal thickness of endometrium in post menopausal state?
< 5mm. then endometrial biopsy is not needed
-
which type of ovarian pathology can lead to PMB and why?
granulosa cell tumour: as it is hormone producing and can cause endometrium to bleed
|
|
