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Define post menopausal bleeding?
- Menstruation after age 55 years
- Vaginal bleeding in the presence of raised FSH and LH values in perimenopausal age group
What are the dangerous causes of postmenopausal bleeding?
Submucous fibroids
Endometrial polyps
Oestrogen therapy
Bleeding from bladder or rectum
Trauma
Atrophic endometritis
What are the frequent causes of postmenopausal bleeding?
Malignancies25%
–Endometrialcarcinoma
–Cervicalcarcinoma
–Uterinesarcomas
–Endometrialhyperplasia
Polypsand fibroids 10-15%
Hormonetherapy 25%
Otherdisorders 10%
What is the approach to a patient with postmenopausal bleeding?
Examination
- Generaland systemic, abdomen
- Noteobesity, diabetes, anemia, hypertension
- Gynaecologic:inspection, speculum, e/e smear, bimanual examination
What special tests should be preformed in a patient with post menopausal bleeding?
–Side-to-side4mm or less: 97% chance for atrophy
Endometrialsampling
–Outpatientprocedure, small vacuum pipettes
D&Cand hysteroscopy
–Ifnot possible to do sampling in office
How do we treat postmenopausal bleeding?
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