Postmenopausal women shouldn’t be bleeding. Every bleeding in them is abnormal and needs to be worked up.
Postmenopausal Bleeding
Definition: Postmenopausal bleeding is any bleeding that occurs >1 year after the last menstrual period. Cancer must always be ruled out.
-Transvaginal U/S is the preferred initial test for painless postmenopausal bleeding. Endometrial biopsy is another option (especially if transvaginal U/S is unavailable)
-Transvaginal U/S showing an endometrial thickness <3-4mm would essentially rule out endometrial carcinoma. Patients with an endometrial thickness > 4 mm should undergo further diagnostic testing, most likely an endometrial biopsy.
An endometrial biopsy is invasive and has low sensitivity for focal lesions.
Saline infusion hysterography should be considered if the endometrial thickness is greater than the threshold, or if an adequate measurement cannot be obtained by ultrasonography. If hysterography shows a global process, then a histologic diagnosis can usually be obtained with an endometrial biopsy, but if a focal lesion is present, a hysteroscopy should be considered as the next diagnostic step.
Abnormal uterine bleeding is the most common gynecological complaint. To determine the cause, it’s best to use a systematic approach.
To be continued.