Postmenopausal Bleeding (PMB)

The most common causes of PMB is caused by the menopause, such as menopause and include:

Vaginal atrophy. Thinning of the lining of the vagina.
Uterine and cervical polyps (these are benign growths in both uterus or cervix).
Hormone replacement therapy (HRT).
Rarely, PMB can be caused by endometrial or cervical or vaginal cancer.

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Rapid Access Gynaecology

I will offer you and carry out an internal examination and also a vaginal ultrasound. I will assess your vagina for evidence of vaginal atrophy, I may perform a smear, or carry out some swabs for infection. The scan will assess the endometrial thickness, and if it is less than 6mm, is normal. I may perform an endometrial biopsy.

Many women will benefit from o a procedure called a hysteroscopya thin telescope is used to assess the endometrial cavity, and I tend to carry this out under general anaesthetic.

Over 90 % of women with PMB do not have cancer. Endometrial cancer tends to present early and can be completely cured.

The most common cause of PMB is vaginal atrophy. This is discussed in another section.
We offer all women an ultrasound scan to assess endometrial thickness.
and if the endometrial thickness is over 6mm, a biopsy or a hysteroscopy is performed to exclude an endometrial cancer.
Some PMB is caused by HRT, and a change in medication may be needed.

The development of ultrasound scans, and high-resolution hysteroscopy has radically improved management. The vaginal ultrasound scan will determine endometrial thickness, and any vascular abnormality.

Modern hysteroscopy allows for targeted biopsies. I use the MyoSure for this to ensure targeted biopsies.

I will exclude a gynaecological cancer, and treat the cause; vaginal atrophy with HRT, and polyps with resection.

I have a family history of Lynch syndrome? I have had a bleed what should I do?

Lynch syndrome will put you at a greater risk of developing endometrial cancer. It is important that you are referred to a Gynaecologist for an immediate assessment and scan.

I had a premature menopause, and have frequent vaginal bleeds after sex, and sex is sore. Why is this, and what should I do?

You are a high risk of developing vaginal atrophy. This is why you are sore, and you need treatment with HRT.

I am 60 years old, and have bloody smelly discharge, what should I do?

You need to see a Gynaecologist urgently; you may have a foreign body trapped in your vagina or have a uterine or cervical cancer.

Can HRT cause PMB?

It can and you will benefit from a Gynaecology review to assess your current medication.

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The most common causes of PMB is caused by the menopause, such as menopause and include:

What investigations are carried out?

What the cause of post-menopausal bleeding PMB and how is it investigated?

How is postmenopausal bleeding managed?

Postmenopausal Bleeding FAQ's

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