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Post Menopausal BleedingObstetrics and Gynaecology > Gynaecology > Abnormal vaginal bleeding R
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.
If there is no local info tab at the top of this box, there is no patient information attached at this time. 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:-
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• 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.

Source: http://www.supportingchoiceintorbay.nhs.uk/reports/pathways/gynae/pmb.pdf