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Postmenopausal Bleeding Research Paper

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POSTMENOPAUSAL BLEEDING
Postmenopausal bleeding (PMB) is bleeding that occurs after menopause has been established for at least one year. It is different from infrequent, irregular periods that occur around the time of menopause.

Causes
1. Obese women and women taking hormone replacement therapy (HRT) are more likely to experience postmenopausal bleeding.
2. Vaginal atrophy is the most common cause of bleeding from the lower reproductive tract.
3. Lesions and cracks on the vulva may also bleed.
4. Sometimes bleeding occurs after intercourse.
5. Bleeding can occur with or without an associated infection.
6. Bleeding from the upper reproductive system can be caused by hormone replacements, endometrial cancer (5-10%), endometrial polyps, …show more content…
Diagnosis is confirmed by endometrial or cervical biopsy. Noninvasive tests include saline infusion sonography (SIS), a refinement of vaginal probe ultrasound.
2. Dilatation and curettage (D and C) are often necessary for definitive diagnosis.

Treatment
Urgent referrals
1. Palpable pelvic mass or lesions suspicious of cancer on vulva or vagina or cervix on examination or on ultrasound.
2. More than one or a single heavy episode of PMB in women aged >55 years (not on HRT).
3. Postcoital bleeding (PCB) in a woman aged >35 years that has persisted for more than 4 weeks.
4. Prolonged or unexpected bleeding that persists for more than 4 weeks after stopping HRT.
Early Referral (within 4-6 weeks)
1. Any other woman with PMB not on HRT who does not satisfy the criteria for ‘urgent referral’ of postmenopausal bleeding.
2. Unexplained repeated postcoital bleeding. Note—in women over 45 years with persistent abdominal distension or pain, ovarian cancer should be considered and, therefore, a pelvic examination should be performed.
3. If excessive bleeding, give hemostatic drugs (oral or intravenous)
4. Postmenopausal bleeding that is not due to cancer and cannot be controlled by any other treatment usually requires a

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