Post menopausal bleeding is one of the most common conditions referred to gynaecology departments. Up to 5% of these women are found to have malignant, or pre-malignant lesions, with early detection and investigation being crucial for curative treatment. We report on the case of a 73-year-old women referred for having regular menses since 14 years of age and discuss the current investigation and management of post menopausal bleeding.
Moodley, M. and Roberts, C. (2004) Clinical pathway for the evaluation of postmenopausal bleeding with an emphasis on endometrial cancer detection. Journal of Obstetrics & Gynaecology, 24, 736-741.
NICE Clinical Guidelines (2005) Referral guidelines for suspected cancer in adults and children. Clinical Governance Research and Development Unit, Department of Health Sciences, University of Leicester.
Gerber, B., Krause, A., Muller, H., Reimer, T., Kulz, T., Kundt, G. and Friese, K. (2001) Ultrasonographic detection of asymptomatic endometrial carcinoma in postmenopausal patients offers no prognostic advantage over symptomatic disease discovered by uterine bleeding. European Journal of Cancer, 37, 64-71.
Gull, B., Karlsson, B., Milsom, I. and Granberg, S. (2003) Can ultrasound replace dilation and curettage? A longitudinal evaluation of postmenopausal bleeding and transvaginal sonographic measurement of the endometrium as predictors of endometrial cancer. American Journal of Obstetrics & Gynecology, 188, 401-408,
Dikkhizen, F., Mol, B., Brolmann, H. and Heintz, A. (2000) The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: A meta-analysis. Cancer, 89, 1765-1772.
Van Doorn, H., Opmeer, B., Burger, C., Duk, M., Kooi, G. and Mol, G. (2007) Inadequate office endometrial sample requires further evaluation in women with postmenopausal bleeding and abnormal ultrasound results. International Journal of Gynecology & Obstetrics, 99, 100-104. http://dx.doi.org/10.1016/j.ijgo.2007.05.040
Epstain, E. and Valentin, L. (2004) Managing women with post-menopausal bleeding. Best Practice & Research Clinical Obstetrics & Gynaecology, 18, 125-143.
Guido, R.S., Kanbour-Shakir, A., Rulin, M.C. and Christopherson, W.A. (1995) Pipelle endometrial sampling. Sensitivity in the detection of endometrial cancer. The Journal of Reproductive Medicine, 40, 553-555.