Post menopausal bleeding - ppt download

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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.
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.
factors. percentage. 1) exogenous estrogens 2)atrophic vaginitis & endometritis. 3)endometrial cancer. 4)endometrial or cervical polyp. 5) endometrial hyperplasia. 6) miscellaneous (cervical cancer ,uterine sarcoma ,urethral caruncle ,trauma). 30% 15% 10% 5%
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.
Absence of oestrogen leads to thin ,dry epithelium with alkaline PH > 7. Postmenopausal vagina shrinks in diameter, splits &tears easily. Tr. HRT.
90% presented with abnormal uterine bleeding. Screening only for high risk population by: 1) pap smear. 2) transvaginal ultrasound .
Urethral caruncle Small fleshy out growth of distal edge of urethra.
most of them are benign. Incidence of malignancy is 1%. Malignant tumours can present as polyp.
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 80-90% accurate
2) aspiration curettage Ex. Vabra aspirator
1) if reviles carcinoma: definitive treatment of cancer. 2) if endometrial hyperplasia: hysteroscopy & D&C. 3) negative & the bleeding recurs or there is strong suspicion of malignancy : Hysteroscopy & D&C.
2)inadequate sample for interpretation. 3) high suspicion of cancer with negative out patient biopsy.
Hysteroscopy Direct inspection of endometrial cavity. Detect 95% of intrauterine abnormality. Sensitive in identifying polyp or sub mucosal fibroid. Can be used as out patient procedure.

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