Management of postmenopausal bleeding

Management of postmenopausal bleeding
NATALIE AM COOPER, MB., T. JUSTIN CLARK MD.

Birmingham Womens Hospital, Birmingham

ABSTRACT
This review article will discuss the evidence supporting the use of outpatient radiological, histological and endoscopic tests for evaluating the endometrium in women presenting with postmenopausal bleeding (PMB). In addition to examining the accuracy and cost-effectiveness of available tests, the review will consider the clinical context in which testing takes place, the impact of patient preferences, the problem of recurrent postmenopausal bleeding and contemporary delivery of rapid access diagnostic services.

Key words endometrium, bleeding, postmenopausal, diagnosis


INTRODUCTION
Postmenopausal bleeding (PMB) is a common clinical problem in both general practice and secondary care, hospital settings. Women are most likely to present with PMB in the sixth decade of life, where consultation rates in primary care are 14.3/1000 population. Similarly, in the hospital setting, abnormal patterns of uterine bleeding account for up to 50% of all gynaecological consultations in the peri- and post-menopausal years (1). The probability of
serious premalignant or malignant endometrial disease (i.e. endometrial cancer and endometrial hyperplasia with cytological atypia) in women presenting with PMB is between 5-15% (2-4) and therefore prompt referral of such women for further investigation is mandatory in order to detect endometrial cancer at an early stage and effect a cure. However, whilst detecting malignant disease is important, we should be mindful that the majority of women have benign causes
for their PMB (Table 1) and so it is imperative that diagnostic testing strategies do not lead to over investigation as this will induce unnecessary inconvenience and morbidity to women
and waste scarce health care resources.

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