Postmenopausal Bleeding
Postmenopausal bleeding is defined as any vaginal bleeding that occurs more than 12 months after your final period. While the cause is often benign, it is critical that postmenopausal bleeding is investigated by a Gynaecologist to rule out more sinister conditions. Michael provides a streamlined and supportive diagnostic pathway to attempt to provide clear answers and a personalised management plan.
Potential Causes:
Atrophy: The most common cause; a thinning of the lining of the uterus or vagina due to low oestrogen levels associated with menopause, which can lead to bleeding or spotting.
Endometrial Polyps: Grape-like growths on the uterine lining that can become fragile and bleed. These should be removed during a procedure and tested under a microscope.
Endometrial Hyperplasia: A thickening of the uterine lining, which in some cases can be a precursor to more serious changes.
Malignancy: Postmenopausal bleeding can be a sign of endometrial or cervical cancer, which is why early investigation is vital.
Clinical Investigations:
Michael utilises a step-by-step approach to identify the source of the bleeding while minimising discomfort:
Pelvic Ultrasound: A transvaginal ultrasound is the first step to measure the thickness of the uterine lining (the endometrial thickness).
Cervical Screening Test: Checking the cervix for abnormal cells using a speculum.
Endometrial Biopsy: A small sample of the uterine lining may be taken during your consultation to check for any abnormal cell changes.
Hysteroscopy D&C: Michael may recommend a minor procedure using a small camera (hysteroscopy) to view the cavity and remove any growths for testing.
Management and Next Steps
Treatment is tailored to the findings of your investigations:
Observation: If the lining is thin and the biopsy is normal, no further treatment may be necessary.
Hormonal Support: If atrophy is the cause, topical oestrogen creams or pessaries can help rejuvenate the health of the vaginal skin and uterus.
Surgical Removal: Polyps identified during a hysteroscopy can be removed during the same procedure for testing and to attempt to stop the bleeding.
Specialist Referral: In the event that cancerous cells are detected, Michael will coordinate care with the appropriate oncological specialists.