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Post Menopausal BleedingObstetrics and Gynaecology > Gynaecology > Abnormal vaginal bleeding
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Published: 15-Apr-2011 Valid until: 16-Mar-2012 Printed on: 18-Apr-2011 Map of Medicine LtdThis pathway was published by Exeter. A printed version of this document is not controlled so may not be up-to-date with the latest clinicalinformation.
Post Menopausal BleedingObstetrics and Gynaecology > Gynaecology > Abnormal vaginal bleeding
• Any bleeding defined as postmenopausal bleeding (PMB)
• Bleeding in women on hormone replacement therapy (HRT)
• Non-menstrual bleeding in premenopausal women
• PMB is defined as an episode of bleeding in a women at least 12 months after her last period
• PMB is any breakthrough bleeding in a woman receiving cyclical HRT, or breakthrough bleeding while receiving continuous
HRT (after first 6 months, or after full amenorrhoea has been established)
• PMB should be considered as a sign of uterine cancer until the diagnosis is excluded
• Main risk factors are age and HRT use
• 1% risk of cancer for those on combined HRT with PMB
• 0.1% risk of cancer for patients under age 50 years with PMB
• 1.5% risk of cancer for patients over age 60 years with PMB
• Women presenting with PMB who are also taking tamoxifen have more than a 10% risk of having uterine cancer and require
2 Patient leaflets and documents relating to this pathway
Quick info:Please see local info tab for patient information.
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3 Joint Formulary relating to this pathway
• nature of the bleeding - timing, quantity, duration
• precipitating events, e.g. trauma, postcoital
• origin of bleeding (could this be arising from urinary tract, vulva or rectum?)
• Associated symptoms - pain, unplanned weight loss, fever, bowel or bladder symptoms
• Past medical history - especially thyroid, renal or hepatic problems
Published: 15-Apr-2011 Valid until: 16-Mar-2012 Printed on: 18-Apr-2011 Map of Medicine LtdThis pathway was published by Exeter. A printed version of this document is not controlled so may not be up-to-date with the latest clinicalinformation.
Post Menopausal BleedingObstetrics and Gynaecology > Gynaecology > Abnormal vaginal bleeding
• Distinguish whether bleeding is postmenopausal (PMB) or that related to hormone replacement therapy (HRT), enquire about:
• possible HRT drug interaction or malabsorption
• whether bleeding occurs in progestogen phase or oestrogen phase of HRT cycle
• possible underlying disease, e.g. hypothyroidism
• Action:patient taking HRT should have 6 week treatment break.
• Look for signs of systemic disease, e.g. bruising for coagulopathy, weight loss
• An abdominal examination and bimanual palpation of the pelvic area
• A speculum examination of the vagina and cervix
• Transvaginal ultrasound is required. If a referral is made via the 2 week wait process the ultrasound will be done at this time.
• While bleeding from the genital area is normally from a uterine source, other anatomical sources should be considered
• Causes of postmenopausal bleeding (PMB) include:
• benign growths, e.g. polyps or fibroids
• breakthrough bleeding in relation to hormone replacement therapy (HRT)
Quick info:Stop HRT for 6 weeks and review patient.
Quick info:Review HRT prescriptions.
Published: 15-Apr-2011 Valid until: 16-Mar-2012 Printed on: 18-Apr-2011 Map of Medicine LtdThis pathway was published by Exeter. A printed version of this document is not controlled so may not be up-to-date with the latest clinicalinformation.
Post Menopausal BleedingObstetrics and Gynaecology > Gynaecology > Abnormal vaginal bleeding
Please see Joint Formulary for further information:-
Quick info:Please see local info tab for Choose and Book service.
• All patients with suspected cancer should be seen within 2 weeks
Service: Two Week Wait Gynaecology-RDE-RH8
Published: 15-Apr-2011 Valid until: 16-Mar-2012 Printed on: 18-Apr-2011 Map of Medicine LtdThis pathway was published by Exeter. A printed version of this document is not controlled so may not be up-to-date with the latest clinicalinformation.
Post Menopausal BleedingObstetrics and Gynaecology > Gynaecology > Abnormal vaginal bleeding
Published: 15-Apr-2011 Valid until: 16-Mar-2012 Printed on: 18-Apr-2011 Map of Medicine LtdThis pathway was published by Exeter. A printed version of this document is not controlled so may not be up-to-date with the latest clinicalinformation.
Agenda der GPN-Studiensitzung in Halle, 17.11.2012, Beginn 9:00 Uhr Begrüßung, Protokollannahme und Bericht des Studienleiters Initial treatment of idiopathic nephrotic syndrome in children with mycophenolate mofetil vs. prednisone: A randomized, controlled, multicenter trial (INTENT Study) M. R. Benz, L. T. Weber (München), B. Tönshoff (Heidelberg) Für das Protokollk
Stanton St Shul Beit Midrash Drinking on Purim י ם ֶכי ִפ ִמ ת ַר ְכ ִנ י ִכּ סי ִס ָע ל ַע ן ִיָי י ֵתֹש ל ָכּ וּל ִלי ֵה ְו וּכ ְבוּ םי ִרוֹכּ ִש וּצי ִק ָהWake up, you drunkards, and weep! Wail, all you drinkers of wine; wail because of the new wine, for it has been snatched from your lips. (Yoel 1:5) Along