Materiały źródłowe

• #1 Approach to the patient with postmenopausal uterine bleeding – UpToDate

  https://www.uptodate.com/contents/approach-to-the-patient-with-postmenopausal-uterine-bleeding/print

  Approach to the patient with postmenopausal uterine bleeding […] Postmenopausal bleeding (PMB) refers to any uterine bleeding in a menopausal patient (other than the expected cyclic bleeding that occurs in patients taking combined [ie, estrogen-progestin], cyclic, postmenopausal hormone therapy). As PMB is the cardinal sign of endometrial carcinoma, all postmenopausal patients with unanticipated PMB should be evaluated for endometrial hyperplasia/carcinoma. More commonly, however, the cause of bleeding in such patients is the result of a benign condition, such as endometrial polyps or atrophy. […] The etiologies and evaluation of postmenopausal patients with uterine bleeding, as well as patients near the end of the perimenopausal transition with abnormal uterine bleeding (AUB), will be reviewed here. […] PMB accounts for approximately 5 percent of office gynecology visits and occurs in approximately 4 to 11 percent of postmenopausal patients. […] The incidence appears to be inversely related to the time since menopause, with the likelihood of bleeding decreasing over time.

• #2 Postmenopausal bleeding

  https://www.nhs.uk/conditions/post-menopausal-bleeding/

  Menopause is usually diagnosed in women over 45 who have not had a period for more than a year. Any bleeding from the vagina after this time needs to be checked by a GP. […] You have postmenopausal bleeding, even if: […] Postmenopausal bleeding is not usually serious, but can be a sign of cancer. Cancer may be easier to treat if it’s found early. […] If you have postmenopausal bleeding, a GP should refer you to hospital or a special postmenopausal bleeding clinic. […] A specialist, who may be a nurse, will offer you tests to help find out what’s causing the bleeding and plan any necessary treatment. […] There can be several causes of postmenopausal bleeding. […] Less commonly, postmenopausal bleeding is caused by cancer, such as ovarian cancer and womb cancer. […] Treatment for postmenopausal bleeding depends on what’s causing it.

• #3 Postmenopausal Bleeding: Causes, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/21549-postmenopausal-bleeding

  Postmenopausal bleeding is vaginal bleeding that occurs a year or more after your last menstrual period. It can be a symptom of vaginal dryness, polyps (noncancerous growths) or other changes in your reproductive system. In about 10% of women, bleeding after menopause is a sign of uterine cancer. […] In most cases, postmenopausal bleeding is due to benign (noncancerous) conditions and isnt a cause for worry. But for about 10% of women, bleeding after menopause is an early sign of uterine cancer (cancer in the lining of your uterus). Talk to your healthcare provider if you experience any bleeding after menopause. Theyll want to run tests to rule out serious medical conditions. […] Any vaginal bleeding that occurs more than a year after your last menstrual period is unusual. This includes light bleeding or spotting, pink or brown discharge and heavy bleeding, even if it only happens once or twice.

• #4 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562188/

  Sharon Sung; Karen Carlson; Aaron Abramovitz. […] Bleeding after menopause has been established, termed postmenopausal bleeding, is considered abnormal and is the reason for approximately two-thirds of all gynecologic office visits in postmenopausal women. […] Therefore, any postmenopausal woman with vaginal bleeding should be promptly and appropriately evaluated through a comprehensive clinical examination and diagnostic studies, including endometrial biopsy and imaging. […] The differential diagnoses associated with postmenopausal bleeding (PMB) include several conditions. […] The most common cause of postmenopausal bleeding is genitourinary atrophy, accounting for 60%. […] Endometrial cancer is the most commonly diagnosed cancer in women and the most common site of uterine cancer, accounting for 92% of cases.

• #5 The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Women With Postmenopausal Bleeding | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/05/the-role-of-transvaginal-ultrasonography-in-evaluating-the-endometrium-of-women-with-postmenopausal-bleeding

  Cancer of the endometrium is the most common type of gynecologic cancer in the United States. Vaginal bleeding is the presenting sign in more than 90% of postmenopausal women with endometrial carcinoma. The clinical approach to postmenopausal bleeding requires prompt and efficient evaluation to exclude or diagnose endometrial carcinoma and endometrial intraepithelial neoplasia. Transvaginal ultrasonography usually is sufficient for an initial evaluation of postmenopausal bleeding if the ultrasound images reveal a thin endometrial echo (less than or equal to 4 mm), given that an endometrial thickness of 4 mm or less has a greater than 99% negative predictive value for endometrial cancer. […] Transvaginal ultrasonography is a reasonable alternative to endometrial sampling as a first approach in evaluating a postmenopausal woman with an initial episode of bleeding.

• #6 Postmenopausal Bleeding > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/postmenopausal-bleeding

  A woman no longer experiences menstrual periods once she enters menopause the term for the natural decline in reproductive hormones a woman experiences in her 40s and 50s. After a year has passed without menstrual periods, any vaginal bleeding that that occurs is known as postmenopausal bleeding, and it is considered abnormal. […] However, between 10% and 15% women who experience postmenopausal bleeding may have endometrial cancer. For this reason, its important for women to see a doctor quickly for assessment after even one episode of postmenopausal bleeding. […] Postmenopausal bleeding refers to any vaginal bleeding that occurs in a menopausal woman. Because all postmenopausal bleeding is considered abnormal, its important to contact your provider if this occurs. […] In some cases, this type of abnormal bleeding may be a sign of endometrial cancer, the most commonly diagnosed gynecological cancer. More than 90% of postmenopausal women with endometrial cancer experience vaginal bleeding (postmenopausal bleeding).

• #7 Closer Look at Postmenopausal Bleeding and Endometrial Cancer – NCI

  https://www.cancer.gov/news-events/cancer-currents-blog/2018/endometrial-cancer-bleeding-common-symptom

  Women experiencing abnormal vaginal bleeding may undergo a transvaginal ultrasound, biopsy, or both, to determine if an endometrial tumor is the cause. […] In the largest analysis to date looking at the extent to which vaginal bleeding is associated with endometrial cancer in women who have gone through menopause, 90% of women diagnosed with endometrial cancer reported bleeding before their cancer diagnosis. Approximately 9% of postmenopausal women who saw a doctor for bleeding later received a diagnosis of endometrial cancer. […] Typically, postmenopausal women who experience bleeding are referred for further testing to either rule out or diagnose endometrial cancer. While vaginal bleeding has been known to be a symptom of endometrial cancer, this large study confirms the practice of referring women for further testing, explained Christina Chu, M.D., of Fox Chase Cancer Center, who was not involved with the research.

• #8 The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Women With Postmenopausal Bleeding | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/05/the-role-of-transvaginal-ultrasonography-in-evaluating-the-endometrium-of-women-with-postmenopausal-bleeding

  If blind sampling does not reveal endometrial hyperplasia or malignancy, further testing, such as hysteroscopy with dilation and curettage, is warranted in the evaluation of women with persistent or recurrent bleeding. […] Transvaginal ultrasonography is not an appropriate screening tool for endometrial cancer in postmenopausal women without bleeding. […] The clinical approach to postmenopausal bleeding requires prompt and efficient evaluation to exclude or diagnose endometrial carcinoma and endometrial intraepithelial neoplasia. […] Transvaginal ultrasonography is appropriate for an initial evaluation of postmenopausal bleeding if the ultrasound images reveal a thin endometrial echo (less than or equal to 4 mm), given that an endometrial thickness of 4 mm or less has a greater than 99% negative predictive value for endometrial cancer.

• #9 Postmenopausal Bleeding > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/postmenopausal-bleeding

  When a woman experiences postmenopausal bleeding, doctors should be able to diagnose the cause of her bleeding after obtaining a medical history, performing a physical exam, and running diagnostic tests. […] The following tests may be used to provide information that leads to a diagnosis: Transvaginal ultrasound, which doctors use to see whether the endometrium (uterine lining) is thicker or thinner than normal. Hysteroscopy, during which a long, thin tube with a camera on its end is inserted into the uterus through the vagina to look for/check for signs of abnormal bleeding. Endometrial biopsy, during which a small sample of the uterine lining is removed and studied under a microscope to look for signs of cancer. Cervical biopsy, a procedure used to check for signs of cancer if any lesions or abnormal areas are discovered on the cervix.

• #10 Postmenopausal Bleeding: Causes, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/21549-postmenopausal-bleeding

  Contact your healthcare provider if you experience bleeding after menopause as it could be a sign of a medical condition. […] Postmenopausal bleeding occurs in about 10% of women over 55. […] Vaginal bleeding after menopause is harmless most of the time. But postmenopausal bleeding can be a sign of a more serious medical condition, such as uterine, cervical or ovarian cancer. Because theres a chance the bleeding is due to cancer, its best to contact your provider for an appointment. […] Your healthcare provider may perform all or some of the following tests to determine whats causing your postmenopausal vaginal bleeding: Pelvic exam to check your vagina and cervix. Pap smear to check for irregular cells on your cervix. Transvaginal ultrasound. Endometrial biopsy to collect cells from your uterine lining.

• #11 Postmenopausal Bleeding | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27521

  Vaginal bleeding is reported in up to 10% of postmenopausal women and is the presenting symptom for approximately two-thirds of gynecologic office visits in this population. […] However, the incidence of PMB may decrease with age. […] Endometrial cancer is the fifth most common cause of death due to malignancy in the US and the fourth most common overall cancer in females. […] Furthermore, endometrial cancer is the most commonly diagnosed cancer in women and the most common site of uterine cancer, accounting for 92% of cases. […] Over 90% of postmenopausal women with endometrial cancer present with PMB. […] The most common etiology for postmenopausal bleeding is an atrophic endometrium. […] The hypoestrogenic environment following menopause leads to genitourinary atrophy. […] A comprehensive history is essential when evaluating PMB to assess both underlying etiologies and establish the patient’s menopausal status.

• #12 Postmenopausal Bleeding—Causes, treatment and Diagnosis

  https://myskyn.co.uk/blog/postmenopausal-bleeding/

  When evaluating vaginal bleeding during postmenopause years, doctors start by understanding your medical history and current symptoms. […] A common test to evaluate postmenopausal bleeding is an endometrial biopsy. It entails taking a small tissue sample from the uterus lining to check for abnormalities or signs of cancer in the lab. […] Ultrasound imaging is another important tool for evaluating postmenopausal bleeding. […] The evaluation for postmenopausal bleeding may also involve laboratory studies. […] According to the NHS UK, the treatment of abnormal vaginal bleeding depends on treating the underlying causes. […] If there is abnormal tissue growth inside your uterus or on your vagina that is causing postmenopausal bleeding, your doctor will surgically remove it. […] If you are experiencing vaginal bleeding due to abnormal cell growth in your womb or cancer, your doctor may consider surgically removing the uterus.

• #13 Postmenopausal Bleeding: Causes, Diagnosis & Treatment | Chrissie Yu

  https://www.chrissieyu.com/insights/about-post-menopausal-bleeding/

  Postmenopausal bleeding, however slight, is not normal, could be serious, and must be checked out. […] In all cases, though, postmenopausal bleeding is not normal, could be a sign of something that needs immediate medical attention, and must be checked out by your doctor. […] Your doctor or gynecologist will probably start out by asking you a load of questions, to try to get a clear picture of your medical background and current situation. […] After you’ve had this discussion, your doctor will probably want to follow up with a physical pelvic exam, perhaps pressing on and around your tummy, and inside your vagina, feeling for lumps, or tenderness, or anything else that doesn’t seem quite right. […] From this point on, next steps will depend on factors including your age, how long it’s been since your last period, and the extent of your bleeding. You may need further tests, such as:

• #14 Postmenopausal Bleeding – Causes & Evaluation (PDF)

  https://gynqi.com/postmenopausal-bleeding-evaluation/

  A Pap test is an office procedure that involves a speculum examination. […] A short office procedure during which a speculum is inserted into the vagina and a small pipelle is placed through the opening of the cervix, and into the uterus to take a sample of the lining of the uterus. […] To facilitate this process, your doctor may recommend a brief procedure in the operating room while you are under anesthesia. […] Hysteroscopy involves inserting a small camera through the vagina and cervix into the uterus, using fluid to expand the uterine cavity. […] A Dilation and Curettage (DC) offers a more detailed assessment of the uterine cavity than an endometrial biopsy. […] Understanding the investigations and procedures related to postmenopausal bleeding is essential for effective diagnosis and management, empowering you to take an active role in your health care.

• #15 Postmenopausal Bleeding – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562188/

  Over 90% of postmenopausal women with endometrial cancer present with PMB. […] The American College of Obstetricians and Gynecologists (ACOG) recommends either transvaginal ultrasound or endometrial biopsy initially to evaluate low-risk women presenting for PMB; performing both studies simultaneously is unnecessary. […] Endometrial sampling is a first-line test for evaluating PMB in any patient because this study provides tissue for histologic diagnosis, which is critical in identifying malignancies. […] A thickened endometrial stripe may be caused by hyperplasia, malignancy, and intracavitary lesions (eg, leiomyomas and endometrial polyps). […] The underlying cause primarily directs the treatment of PMB. […] Clinicians should provide perimenopausal patients with anticipatory education regarding menopausal transition and typical changes that may occur during menstrual cycles.

• #16

  https://www.nursingcenter.com/journalarticle?Article_ID=597100&Journal_ID=54012&Issue_ID=597063

  Although postmenopausal bleeding (PMB) accounts for only 5% of all gynecologic office visits, its evaluation is a source of consternation for many providers. The top three diagnoses associated with PMB are endometrial atrophy (40% to 50%), endometrial cancer (10%), and polyps (3%). Because 90% of PMB is associated with a benign condition, the ideal diagnostic method is noninvasive. This reduces individual risk and increases accurate diagnosis of malignancy. […] Ultrasonography is nonsurgical and a relatively noninvasive diagnostic method for evaluation of PMB, and its use is now widespread. […] Transvaginal ultrasound (TVUS) is the least invasive diagnostic tool for the evaluation of PMB, and is fairly accurate in ruling out malignancy. It is typically used in the initial evaluation of PMB and after an unsuccessful EMB to confirm the result and to guide further diagnostic tests.

• #17

  https://www.nursingcenter.com/journalarticle?Article_ID=597100&Journal_ID=54012&Issue_ID=597063

  The specificity of EMB is 99.1%, the sensitivity 84.2%, the accuracy 96.9%, and the positive and negative predictive values 94.1% and 93.7%, respectively. This demonstrates that a diagnosis of endometrial cancer on biopsy is definitive and should lead to treatment. A negative biopsy, however, may require further evaluation, especially if symptoms persist. […] Ultrasonographic measurement of the endometrium, a commonly used diagnostic tool for PMB, entails inserting a probe attached to a transducer into the vagina. The transducer then measures the endometrium to the nearest millimeter. The endometrium looks like a stripe under sonography, hence the term „endometrial stripe” (EMS). Endometrial stripe is commonly used when referring to endometrial measurements. An EMS measurement 5 mm is considered abnormal. This was determined by multiple studies of EMS measurements. Measurements 5 mm were highly correlated with a histologic diagnosis of endometrial cancer.

• #18 Postmenopausal bleeding: First steps in the workup | MDedge

  https://mdedge.com/familymedicine/article/64874/womens-health/postmenopausal-bleeding-first-steps-workup

  Endometrial cancer is the key concern. While endometrial cancer is the most serious cause of PMB, it is not the most common. Atrophic endometrium is the culprit 60% to 80% of the time, while endometrial cancer accounts for up to 10% of cases. […] A workup for PMB starts with a thorough medical history and a physical examination, including a Pap smear to screen for cervical cancer. […] Laboratory tests are generally not helpful in evaluating PMB itself. A complete blood count is warranted if the bleeding is prolonged or heavy, however, and testing for sexually transmitted diseases may be appropriate, based on the patient’s history and/or physical exam. […] Endometrial biopsy or transvaginal ultrasound: Which test is better? For many years, dilatation and curettage (D&C) of the endometrium was standard practice in the evaluation of patients with PMB. The Society of Radiologists in Ultrasound (SRU) and the American College of Obstetricians and Gynecologists (ACOG) now advise starting with either endometrial biopsy (EMB) or transvaginal ultrasound (TVUS).

• #19 The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Women With Postmenopausal Bleeding | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/05/the-role-of-transvaginal-ultrasonography-in-evaluating-the-endometrium-of-women-with-postmenopausal-bleeding

  Transvaginal ultrasonography can be useful in the triage of women in whom office endometrial sampling was performed but tissue was insufficient for diagnosis. […] Failure to adequately identify a thin, distinct endometrial echo in a postmenopausal woman with bleeding should trigger sonohysterography, office hysteroscopy, or endometrial sampling. […] Because rare cases of endometrial carcinoma (particularly type II) can present with an endometrial thickness of less than 3 mm, persistent or recurrent uterine bleeding should prompt a histologic evaluation of the endometrium regardless of endometrial thickness. […] An endometrial measurement greater than 4 mm that is incidentally discovered in a postmenopausal patient without bleeding need not routinely trigger evaluation, although an individualized assessment based on patient characteristics and risk factors is appropriate.

• #20 Postmenopausal bleeding: Don’t worry — but do call your doctor – Harvard Health

  https://www.health.harvard.edu/womens-health/postmenopausal-bleeding-dont-worry-but-do-call-your-doctor

  Study authors said that their findings show that checking for endometrial cancer in women who experience postmenopausal bleeding could potentially find as many as 90% of these cancers. But the only way to find those cases is to properly evaluate all women with bleeding, most of whom will not have cancer. […] So, if you do experience unusual or postmenopausal bleeding, make an appointment with your doctor to have the problem investigated, says Dr. Berkowitz. Your doctor will likely recommend an ultrasound, a biopsy, or both. […] Dr. Berkowitz stressed the importance of doing both tests because not all endometrial cancers thicken the uterine lining. […] „Assuming the patient does not have any health issues, such as serious heart disease, and is otherwise healthy, doing a biopsy would be the safest, most assured way to rule out endometrial cancer,” says Dr. Berkowitz.

• #21

  https://www.nursingcenter.com/journalarticle?Article_ID=597100&Journal_ID=54012&Issue_ID=597063

  Although the EMS measurement offers a noninvasive and potentially cost-effective method of evaluating PMB, there are factors associated with its use that are problematic. If the EMS is inaccurately measured 5 mm (a false positive result), the patient will be subjected to further invasive tests such as D C or hysteroscopy in order to obtain endometrial tissue for histological assessment. […] Another important diagnostic tool that has recently come into use is saline sonohysterography. This out-patient procedure allows a visual evaluation of the uterine cavity. It is useful in diagnosing intracavitary lesions such as polyps, leiomyoma, and masses. It does not, however, provide a histologic diagnosis. This test is highly sensitive (97%), and also has a high negative predictive value (94.3%) when combined with EMB.

• #22 Postmenopausal bleeding: First steps in the workup | MDedge

  https://mdedge.com/familymedicine/article/64874/womens-health/postmenopausal-bleeding-first-steps-workup

  Is it endometrial cancer? When a postmenopausal woman presents with unexpected vaginal bleeding, this algorithm and review can help you answer that question without delay. […] Screen all women with postmenopausal vaginal bleeding (PMB) for endometrial cancer. […] Use transvaginal ultrasound for the initial study for patients at low risk for endometrial cancer, and endometrial biopsy for those at higher risk. […] Use saline infusion sonography as a second step in the evaluation of PMB if the diagnosis remains unclear after a biopsy or the bleeding persists despite a normal initial workup. […] Vaginal bleeding, which more than 90% of women with endometrial cancer experience, is often the first sign of malignancy. Thus, all women who present with postmenopausal bleeding (PMB)—defined as any vaginal bleeding occurring ≥1 year after cessation of menses or any unscheduled bleeding in women on hormone replacement therapy (HRT)—require further evaluation.

• #23 Role of MRI in Diagnosis of Postmenopausal Bleeding Causes

  https://ctv.veeva.com/study/role-of-mri-in-diagnosis-of-postmenopausal-bleeding-causes

  MRI is an emerging modality for various reasons, such as exquisite soft-tissue resolution, its capability of multiplanar imaging, characterization, high sensitivity, and lack of ionizing radiation. […] The sensitivity of MRI in identifying acute uterine pathologies is 96.6%. With recent advances in MR imaging techniques, diffusion weighted (DW) imaging and ADC value are useful in characterization of endometrial lesions because malignant lesions show high cellularity with little extracellular space which give restricted motion of water molecules and lower ADC values in contrast to benign lesions and normal tissues.

• #24 Postmenopausal Bleeding: Role of Imaging in the Diagnosis and Management | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-030-69476-0_12

  Menopause is defined as no bleeding for 12 months and results from the depletion of ovarian follicles. Bleeding is a significant complaint among postmenopausal women and is reported in about 10% of women in this group. A small but significant number of such women will be diagnosed with endometrial cancer. Endometrial cancer is the most common gynecological cancer with vaginal bleeding being the most common presenting sign and is so in 90% of postmenopausal patients with endometrial carcinoma. […] Endometrial thickness measured during an endovaginal pelvic ultrasound is the established initial assessment to triage patients to receive endometrial biopsy. Common causes of postmenopausal bleeding include endometrial atrophy, endometrial polyps, and endometrial hyperplasia. Some of these causes are readily diagnosed on ultrasound evaluation. The supplemental use of Saline infused sonohysterography adds to the diagnostic value of ultrasound assessment of the endometrium. Hysteroscopy allows direct visualization and guided biopsy and/or resection of endometrial lesions causing abnormal bleeding in selected cases. Magnetic resonance imaging is useful for the assessment of the endometrium for narrowing the differential diagnosis of endometrial abnormalities and for staging of endometrial cancers. Majority of the patients with vaginal bleeding actually bleed secondary to atrophic changes in the vagina or the endometrium.

• #25 Postmenopausal Bleeding | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27521

  Excluding a malignant etiology, primarily endometrial cancer, is the most critical aspect of PMB evaluation. […] In addition to the clinical assessment, diagnostic evaluation of PMB is primarily directed toward excluding endometrial hyperplasia or malignancy. […] Endometrial sampling is a first-line test for evaluating PMB in any patient because this study provides tissue for histologic diagnosis, which is critical in identifying malignancies. […] The underlying cause primarily directs the treatment of PMB. […] The primary complication of PMB is secondary anemia, which occurs in approximately 10% of postmenopausal women. […] Gynecologists are frequently consulted to evaluate and manage patients with PMB. […] Clinicians should provide perimenopausal patients with anticipatory education regarding menopausal transition and typical changes that may occur during menstrual cycles. […] Postmenopausal bleeding presents a diagnostic challenge due to its diverse etiologies, requiring a comprehensive and collaborative approach by an interprofessional team to ensure patient-centered care.

• #26 Office hysteroscopic evaluation of postmenopausal bleeding | MDedge

  https://blogs.the-hospitalist.org/content/office-hysteroscopic-evaluation-postmenopausal-bleeding

  A negative tissue biopsy result in women with PMB is not considered to be an endpoint, and further evaluation with hysteroscopy to evaluate for focal disease is imperative. […] Hysteroscopy is the gold standard for evaluating the uterine cavity, diagnosing intrauterine pathology, and operative intervention for some causes of AUB. […] Hysteroscopy plays a critical role in additional evaluation and diagnosis of endometrial carcinoma with directed biopsy, especially in a symptomatic woman with PMB. […] If the endometrial biopsy does not explain the etiology of the PMB with atypical hyperplasia or endometrial cancer, then hysteroscopy should be performed to evaluate for focal endometrial disease and possible directed biopsy.

• #27 Clinical and Sonographic Evaluation of Postmenopausal Bleeding (PMB) Followed by Diagnostic and/or Therapeutic Hysteroscopy and Guided Biopsy in Jordanian Hospitals

  https://www.mdpi.com/1648-9144/56/4/147

  Clinical and Sonographic Evaluation of Postmenopausal Bleeding (PMB) Followed by Diagnostic and/or Therapeutic Hysteroscopy and Guided Biopsy in Jordanian Hospitals […] The goal of this study was to evaluate the clinical sonographic evaluation of postmenopausal bleeding (PMB) followed by diagnostic and/or therapeutic hysteroscopy and guided biopsy in Jordanian hospitals. […] Hysteroscopy was observed to be effective for the diagnosis of postmenopausal bleeding. […] There is a need to assess more approaches for the diagnosis of postmenopausal bleeding among women. […] An increased risk of endometrial cancer has been observed among women experiencing postmenopausal bleeding and an endometrial thickness greater than 4 mm at initial workup. […] The effectiveness of hysteroscopy and guided biopsy has been investigated for the diagnosis of postmenopausal bleeding.

• #28 Office hysteroscopic evaluation of postmenopausal bleeding | MDedge

  https://community.the-hospitalist.org/content/office-hysteroscopic-evaluation-postmenopausal-bleeding

  The high possibility of endometrial carcinoma in postmenopausal women warrants that any patient who is symptomatic with PMB should be presumed to have endometrial cancer until the diagnostic evaluation process proves she does not. […] A thickened endometrium on TVUS (4 mm in a postmenopausal woman with PMB) warrants additional evaluation with endometrial sampling. […] ACOG recommends that endometrial biopsy be performed for women older than age 45. […] Endometrial biopsy has some diagnostic shortcomings, however. […] Therefore, a negative tissue biopsy result in women with PMB is not considered to be an endpoint, and further evaluation with hysteroscopy to evaluate for focal disease is imperative. […] Hysteroscopy is the gold standard for evaluating the uterine cavity, diagnosing intrauterine pathology, and operative intervention for some causes of AUB.

• #28 Office hysteroscopic evaluation of postmenopausal bleeding | MDedge

  https://community.the-hospitalist.org/content/office-hysteroscopic-evaluation-postmenopausal-bleeding

  Postmenopausal bleeding (PMB) is the presenting sign in most cases of endometrial carcinoma. Prompt evaluation of PMB can exclude, or diagnose, endometrial carcinoma. […] Although no general consensus exists for PMB evaluation, it involves endometrial assessment with transvaginal ultrasonography (TVUS) and subsequent endometrial biopsy when a thickened endometrium is found. […] When biopsy results reveal insufficient or scant tissue, further investigation into the etiology of PMB should include office hysteroscopy with possible directed biopsy. […] AUB is present in more than 90% of postmenopausal women with endometrial carcinoma, which leads to diagnosis in the early stages of the disease. […] Approximately 3% to 7% of postmenopausal women with PMB will have endometrial carcinoma.

• #29

  https://www.ijrcog.org/index.php/ijrcog/article/view/12061

  Postmenopausal bleeding (PMB) is considered a red flag symptom and warrants further examination and evaluation. […] Trans-vaginalsonography (TVS) can be used reliably to diagnose fibroids, polyps and thickened endometrium. […] Hysteroscopy is considered gold standard for evaluating endometrial cavity. […] Present study was designed and carried out to study aetiology and prevalence of PMB in Central India as well as to evaluate the efficacy of TVS and hysteroscopy in diagnosis of different endometrial pathologies in patients with PMB. […] The diagnostic accuracy of ET by TVS at a cut-off point of 5 mm was 94% with sensitivity 89.3%, specificity 100%, PPV 100% and NPV 88%. […] The diagnostic accuracy of hysteroscopy was 98% with sensitivity 96.4%, specificity 100%, PPV 100% and NPV 95.7%.

• #30 Postmenopausal bleeding: First steps in the workup | MDedge

  https://mdedge.com/familymedicine/article/64874/womens-health/postmenopausal-bleeding-first-steps-workup

  Both procedures are more advantageous than D&C for evaluating PMB because they can be done in an outpatient setting, are less expensive, provide faster results, and correlate with surgical findings more than 95% of the time. […] Many physicians prefer to start with EMB, because it provides tissue samples for a histological diagnosis, is easily performed, and causes minimal cramping.

• #31 Postmenopausal Vaginal Bleeding | Radiology Key

  https://radiologykey.com/postmenopausal-vaginal-bleeding/

  There are several ways to obtain an endometrial tissue specimen for pathological evaluation. Endometrial tissue can be obtained by dilation and curettage (DC), usually performed in an operating room, or via an office biopsy. The latter is substantially lower in cost and morbidity. Both of these procedures obtain tissue from only a portion of the endometrium and so may miss lesions due to sampling error. […] Both DC and office biopsy have been shown to have sensitivities below 100% for endometrial pathology, with polypoid lesions being missed most frequently. […] Another method of obtaining endometrial tissue for pathological examination is hysteroscopically guided biopsy. Because the biopsy is not performed blindly, but instead can be directed to sites of grossly visible abnormalities, this approach is less prone to sampling error.

• #32 Postmenopausal Bleeding (PMB) | Doctor

  https://patient.info/doctor/postmenopausal-bleeding

  The British Gynaecological Cancer Society’s 2021 guidelines recommend a cutoff endometrial thickness of 4mm; women with postmenopausal bleeding and an endometrial thickness of 4mm (without any irregularities in the endometrium) can be reassured without any further investigations, unless there is recurrent PMB. […] A definitive diagnosis in PMB is made by histology. […] Most women with PMB will not have significant pathology but the dictum remains that postmenopausal bleeding is cancer until proved otherwise. […] Women with breast cancer who take tamoxifen on a long-term basis are at increased risk of endometrial cancer.

• #32 Postmenopausal Bleeding (PMB) | Doctor

  https://patient.info/doctor/postmenopausal-bleeding

  Postmenopausal bleeding (PMB) is defined for practical purposes as vaginal bleeding occurring after twelve months of amenorrhoea, in a woman of the age where the menopause can be expected. […] Although PMB usually has a benign cause, the priority is to exclude malignancy. […] PMB is a common problem representing 5% of all gynaecology outpatient attendances. These are most commonly to eliminate endometrial cancer as the cause of the bleed. […] History and examination may possibly indicate cause, but it is generally accepted that PMB should be treated as malignant, until proved otherwise. […] This requires referral to a gynaecologist with an appointment within two weeks. […] TVUS is an appropriate first-line procedure to identify which women with PMB are at higher risk of endometrial cancer.

• #33 Clinical perspective to postmenopausal bleeding and its diagnostic evaluation: a mini review – MedCrave online

  https://medcraveonline.com/MOJWH/clinical-perspective-to-postmenopausal-bleeding-and-its-diagnostic-evaluation-a-mini-review.html

  Persistent or recurrent bleeding needs further evaluation even in cases with ET less than 4 mm, especially in association with other risk factors. […] If blind endometrial sampling does not reveal any significant pathology and patient is high risk, further evaluation with hysteroscopic guided biopsy should be done. […] Further studies on larger population are required to define the cutoff for endometrial thickness for patients on hormonal therapy and on tamoxifen, so that they can be evaluated timely.

• #34 Closer Look at Postmenopausal Bleeding and Endometrial Cancer – NCI

  https://www.cancer.gov/news-events/cancer-currents-blog/2018/endometrial-cancer-bleeding-common-symptom

  If you have bleeding after menopause, you should call your doctor and let them know, said Dr. Chu. For the majority of women, it’s a benign problem, but there are simple things that can be done to rule out endometrial cancer. […] Overall, the analysis showed that, consistent with what had been seen in earlier studies, 90% of women diagnosed with endometrial cancer had experienced postmenopausal bleeding. […] The number of women with postmenopausal bleeding who were diagnosed with endometrial cancer varied around the globe. While the rate was 9% overall, it ranged from 5% in North America to 13% in Western Europe. […] Among the studies included in the analysis, the risk of endometrial cancer in women with postmenopausal bleeding was lower in studies that included women using hormone replacement therapy.

• #35 Closer Look at Postmenopausal Bleeding and Endometrial Cancer – NCI

  https://www.cancer.gov/news-events/cancer-currents-blog/2018/endometrial-cancer-bleeding-common-symptom

  It’s only if there’s persistent bleeding after the initial 6 months of [hormone replacement] that it may be more concerning and should trigger testing for endometrial cancer, she said. […] Currently, testing for endometrial cancer in women experiencing abnormal vaginal bleeding consists of transvaginal ultrasound imaging, biopsy, or both. […] Before sending a woman for testing, doctors should ask themselves: If she has postmenopausal bleeding, how high is her risk of cancer?” explained Dr. Wentzensen. „Our estimate of 10% supports the current practice of further evaluating these women.” […] The findings confirm that „postmenopausal women with [vaginal] bleeding have a low risk of endometrial cancer, but the vast majority of women with endometrial cancer present with bleeding. […] women should know that getting tested if they have postmenopausal bleeding „gives us an opportunity to [potentially] detect endometrial cancer early, which provides a high likelihood of cure.

• #36 Abnormal Uterine Bleeding: Postmenopausal and Menopausal Transition | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688239/all/Abnormal_Uterine_Bleeding:_Postmenopausal_and_Menopausal_Transition

  Postmenopausal AUB is defined as uterine bleeding that occurs 1 year after last menstruation or unscheduled bleeding for women taking hormone replacement therapy (HRT). […] Women taking HRT may have irregular bleeding for several months after initiation of therapy. Bleeding that recurs after a long bleed-free period should be considered abnormal and prompt further investigation. […] Incidence of postmenopausal AUB is as high as 10%, with majority of cases occurring shortly after menopause. […] AUB is most commonly caused by endometrial polyps or atrophy. […] Prevalence of endometrial cancer among postmenopausal women is 0.7% but increases with additional risk factors. Among with postmenopausal AUB, risk of endometrial cancer is significantly higher, approximately 9%. […] Initial tests for postmenopausal bleeding should include urine or serum hCG to exclude pregnancy, thyroid function tests, follicle-stimulating hormone (FSH), serum prolactin level, complete blood count (CBC), and consider coagulopathy.

• #37 Diagnosis and Management of Endometrial Cancer | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0315/p468.html

  The American College of Obstetricians and Gynecologists (ACOG) recommends that women with abnormal uterine bleeding be evaluated for endometrial cancer if they are older than 45 years, or if they are younger than 45 years and have a history of unopposed estrogen exposure. […] Most guidelines recommend either transvaginal ultrasonography or endometrial biopsy as the initial study for the evaluation of endometrial cancer. […] Transvaginal ultrasonography is often the initial diagnostic study of choice when evaluating for endometrial cancer because of its availability, cost-effectiveness, and high sensitivity. […] Postmenopausal patients with endometrial thickness greater than 5 mm should be evaluated with a tissue sample, especially if bleeding is present. […] The definitive diagnosis of endometrial cancer requires an endometrial tissue sample. […] If an adequate sample cannot be obtained, a referral for dilation and curettage should be considered.

• #38 Diagnostic Strategies for Postmenopausal Bleeding

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2821624/

  Guidelines addressing PMB are therefore aimed at excluding cervical cancer, endometrial carcinoma or precancerous lesions of the endometrium. […] Patients with an increased endometrial thickness should undergo more invasive testing, that is, office endometrial sampling, hysteroscopy or dilation and curettage (DC), to exclude endometrial pathology. […] Guidelines advocate office endometrial sampling to rule out endometrial carcinoma in women with PMB and an increased endometrial thickness, measured with TVS. […] Sensitivity of TVS endometrial thickness measurement in women with PMB is still controversial. Future research should aim at achieving a higher accuracy of the diagnostic strategy applied. Such higher accuracy might be achieved by incorporation of patient’s characteristics (e.g., age, presence of diabetes, Body Mass Index (BMI), presence of hypertension) in the diagnostic work-up.

• #39 Office hysteroscopic evaluation of postmenopausal bleeding | MDedge

  https://community.the-hospitalist.org/content/office-hysteroscopic-evaluation-postmenopausal-bleeding

  Hysteroscopy plays a critical role in additional evaluation and diagnosis of endometrial carcinoma with directed biopsy, especially in a symptomatic woman with PMB. […] If the endometrial biopsy does not explain the etiology of the PMB with atypical hyperplasia or endometrial cancer, then hysteroscopy should be performed to evaluate for focal endometrial disease and possible directed biopsy.

• #40 Postmenopausal Bleeding: Causes, Symptoms, Diagnosis, and Treatment – Sukhi Pariwar Clinic

  http://sukhipariwarclinic.com.np/postmenopausal-bleeding-causes-symptoms-diagnosis-and-treatment/

  Hysteroscopy: A procedure in which a small camera is inserted into the uterus through the cervix to directly visualize the uterine cavity and identify any abnormalities. […] Pap Smear: This test screens for cervical cancer by collecting cells from the cervix for examination. […] Blood Tests: These may be done to evaluate hormone levels and rule out other potential causes of bleeding. […] Postmenopausal bleeding is a symptom that should never be ignored. It can also be an early sign of serious diseases such as cancer. Prompt evaluation and diagnosis by a healthcare provider are essential to determine the cause and appropriate treatment. Regular check-ups and awareness of symptoms can help in early detection and improve outcomes for women experiencing postmenopausal bleeding.

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