Postmenopausal bleeding

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

273

Pages:

6
Author:

Mariam A. A.

Post-Menopausal Bleeding History Did she have any bleeding before the 6 weeks? Did it common on suddenly? Is it always there? Of not -> how often? How much blood is there? What colour is the blood? Are there clots? Is there pain in the vaginal area? Is there any itch? Is there vaginal dryness Is there pelvic or abdominal pain? Is there discharge? Is there any vomit? Any weight changes? Any changes to appetite? Any night sweats? Urinary symptoms Frequency Pain Amount Urgency Bowel symptoms Age of menopause How long did it take for the period to completely cease? During menopause how often would bleed What symptoms of menopause symptoms did she have? E.g. hot flushes, night sweats, sleep issues, mood changes, vaginal dryness. Fatigue and joutn pain Did she receive any treatment for menopause symptoms Menstrual cycle Age of menarche Examination Vitals General appearance – features of anaemia (impact of the extent of the bleeding) Abdominal examination Masses, tenderness, and scars for previous surgeries Breast cancer Bimanual examination Ulcers, scars, FGM, varicosities, inguinal lymph nodes Vagina, cervix, uterus and adnexa Position, size, tenderness, cervical motion tenderness, irregularities, masses. May be unhelpful in large women because of their body habitus Speculum examination Examination of the cervix and vagina Vaginal wall Features of inflammation, ulcerations and atrophy Discharge: colour, consistency and smell -> infections or malignancy Lesions or masses Bleeding or trauma Cervix Appearance -> regular or irregular Colour: Pink (normal), blue (pregnancy), pale (atrophy), red (inflammation) Discharge from os and opening of os: open or closed (pregnancy status) Lesions Motion tenderness Foreign bodies Prolapse Fistulas Sample collection High cervical swab, low cervical swap, CST smear and culture swaps Investigations Bloods: FBCs, iron studies, coagulation studies, urea and electrolytes and LFTs Abdominal ultrasound and a transvaginal ultrasound Mammograms Hysteroscopy + Bx (D+C) High and low cervical swaps What features of ultrasound do you need to look for Endometrial thickness -> should be less than 4 mm in post-menopausal women and 4 to 8 mm in premenopausal women Morphologies of the ovaries Size and dimensions of the uterus Myometrium invasion Fluid in endometrial cavity Endometrial contour Management Surgical staging – gold standard Total hysterectomy + bilateral salpino -oophorectomy Pelvic lymph node sampling Otherwise No lymphadenectomy No adjunctive therapy – as stage one is confined to the endometrium and has excellenet prognosis