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    Lec. 4 - Post Menopausal Bleeding

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    Dr-Saja O. Dmour
    This document summarizes a lecture on post-menopausal bleeding given by Dr. Shaimaa Kadhim. It outlines the main causes of post-menopausal bleeding as exogenous estrogens, atrophic vaginitis, endometrial cancer, endometrial or cervical polyps, and endometrial hyperplasia. The management of post-menopausal bleeding involves examination, transvaginal ultrasound, and endometrial sampling procedures like aspiration biopsy or curettage. Endometrial cancer is the most common cause and requires definitive cancer treatment, while other findings may require hysteroscopy and D&C.

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    Lec. 4 - Post Menopausal Bleeding

    Uploaded by

    Dr-Saja O. Dmour
    33 views6 pages
    This document summarizes a lecture on post-menopausal bleeding given by Dr. Shaimaa Kadhim. It outlines the main causes of post-menopausal bleeding as exogenous estrogens, atrophic vaginitis, endometrial cancer, endometrial or cervical polyps, and endometrial hyperplasia. The management of post-menopausal bleeding involves examination, transvaginal ultrasound, and endometrial sampling procedures like aspiration biopsy or curettage. Endometrial cancer is the most common cause and requires definitive cancer treatment, while other findings may require hysteroscopy and D&C.

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    Lec. 4 - Post menopausal bleeding

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    This document summarizes a lecture on post-menopausal bleeding given by Dr. Shaimaa Kadhim. It outlines the main causes of post-menopausal bleeding as exogenous estrogens, atrophic vaginitis, endometrial cancer, endometrial or cervical polyps, and endometrial hyperplasia. The management of post-menopausal bleeding involves examination, transvaginal ultrasound, and endometrial sampling procedures like aspiration biopsy or curettage. Endometrial cancer is the most common cause and requires definitive cancer treatment, while other findings may require hysteroscopy and D&C.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    33 views6 pages

    Lec. 4 - Post Menopausal Bleeding

    Uploaded by

    Dr-Saja O. Dmour
    This document summarizes a lecture on post-menopausal bleeding given by Dr. Shaimaa Kadhim. It outlines the main causes of post-menopausal bleeding as exogenous estrogens, atrophic vaginitis, endometrial cancer, endometrial or cervical polyps, and endometrial hyperplasia. The management of post-menopausal bleeding involves examination, transvaginal ultrasound, and endometrial sampling procedures like aspiration biopsy or curettage. Endometrial cancer is the most common cause and requires definitive cancer treatment, while other findings may require hysteroscopy and D&C.

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    You are on page 1of 6

    Total Lectures : 26

    gynecology

    Dr. Shaimaa Kadhim

    oj
    Post-menopausal bleeding

    Lec . 4
    Tue. 22\12\2016

    Done by : Ali Faleh

    ‫مكتب اشور لالستنساخ‬ 2016-2017


    Post-menopausal bleeding Dr. Shaimaa Kadhim 22\12\2016

    Post menopausal bleeding


    Introduction:
    Bleeding occurs after menopause (one or more year without cycle )

    Age (50_55) with average age 51.5 years.

    Pmb is always abnormal &should be investigated.

    Menstruation after 55 years is abnormal.

    Causes:
    1) exogenous estrogens 30%

    2) atrophic vaginitis & endometritis 30%


    3)endometrial cancer 15%

    4)endometrial or cervical polyp 10%

    5) endometrial hyperplasia 5%

    6) miscellaneous (cervical cancer ,uterine sarcoma ,urethral caruncle ,trauma). 10%

    Exogenous estrogens :
    Hystroctomized patients: estrogens only

    Non hystroctomized: oestrogen & progesterone to prevent endometrial hyperplasia.

    Severe continuous bleeding more than 4 months of HRT use should be investigated.

    Genital tract atrophy :


    Absence of oestrogen leads to thin ,dry epithelium with alkaline PH > 7.

    Postmenopausal vagina shrinks in diameter, splits &tears easily.

    1 By : Ali Faleh
    Post-menopausal bleeding Dr. Shaimaa Kadhim 22\12\2016

    Treatment : HRT (hormone replacement therapy)

    ENDOMETRIAL CARCINOMA :
    90% presented with abnormal uterine bleeding. Screening only for high risk patient by:

    1) pap smear.

    2) transvaginal ultrasound .

    Urethral caruncle :
    Small fleshy out growth of distal edge of urethra.

    Endometrial & cervical polyp :


    most of them are benign. Incidence of malignancy is 1%.

    Malignant tumours can present as polyp.

    2 By : Ali Faleh
    Post-menopausal bleeding Dr. Shaimaa Kadhim 22\12\2016

    Management :
    History :-
    1) risk factors of endometrial cancer. 2) trauma (coitus)

    3)family or personal history of malignancy. 4) drug history

    Examination :-
    General examination ---- Abdominal examination ---- Pelvic examination

    Speculum examination & pap smear.

    Transvaginal ultrasound
    Suspicious findings:

    1) end. Thickness > 4-5 mm. 2) irregular endometrial outline.

    3) fluid in the end. Cavity. 4) mass.

    If end. thickness <4-5 mm. only reassure the patient.

    Out patient endometrial sampling :

    1) aspiration biopsy :

    A) Novak curet B) pipelle Both are 80-90% accurate

    2) aspiration curettage :

    Ex. Vabra aspirator

    3 By : Ali Faleh
    Post-menopausal bleeding Dr. Shaimaa Kadhim 22\12\2016

    aspiration biopsy

    Aspiration curettage

    4 By : Ali Faleh
    Post-menopausal bleeding Dr. Shaimaa Kadhim 22\12\2016

    Interpretation of results
    1) if reviles carcinoma: definitive treatment of cancer.

    2) if endometrial hyperplasia: hysteroscopy & D&C.

    3) negative & the bleeding reoccurs or there is strong suspicion of malignancy :

    Hysteroscopy & D&C.

    D&C under general anaesthesia Indicated in:

    1)unsuccessful out patient sampling.

    2)inadequate sample for interpretation.

    3) high suspicion of cancer with negative out patient biopsy

    Hysteroscopy :
    Direct inspection of endometrial cavity. Can Detect 95% of intrauterine abnormality.

    Sensitive in identifying polyp or sub mucosal fibroid. Can be used as out patient
    procedure.

    5 By : Ali Faleh

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