Makindo Medical Notes

Post Menopausal Bleeding 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 more than 6 months after menopause
• Bleeding may be pink, spotting, or brown discharge
• Occurs in approximately 20% of women

Concerns/Causes:

• Cervical cancer: A rare but serious cause of postmenopausal bleeding
• Endometrial cancer: Around 10% of women with postmenopausal bleeding have endometrial cancer. In almost all cases, bleeding is the first sign.
• Endometrial atrophy: Thinning of the endometrial lining due to reduced estrogen levels
• Cervical polyps: Usually benign, these polyps are found in the lower uterus near the cervix
• Atrophic vaginitis: Inflammation due to reduced estrogen levels
• Endometrial hyperplasia: Thickening of the uterine lining due to excess estrogen without sufficient progesterone, often associated with HRT and a risk factor for endometrial cancer
• HRT (Hormone Replacement Therapy): Can cause light postmenopausal bleeding

Ask About:

• Are they taking HRT?
• Cramping, abdominal, back, or pelvic pain
• Pain with sexual intercourse
• Fatigue, sudden weight gain or loss
• Changes in bowel movements or constipation
• Fever and chills, indicating possible infection

Investigations:

• FBC, U&E, CRP
• Clotting screen
• Cervical smear
• Thyroid function tests (TFTs)
• Transvaginal ultrasound scan (USS) and endometrial biopsy
• Hysteroscopy and biopsy for further assessment

Management:

• Refer for urgent gynecological diagnostic assessment at a specialized postmenopausal bleeding clinic to exclude malignancy
• Dilation and Curettage (D&C): Performed under general anesthesia, this involves scraping the uterine lining to remove dysfunctional cells causing the bleeding
• Avoid the use of anticoagulants and aspirin to prevent bleeding complications
• Anti-fibrinolytic therapy: Consider using Tranexamic acid to control bleeding
• Avoid using tampons; use pads to prevent irritation of the vaginal lining