Postmenopausal bleeding

Vaginal bleeding occuring any time after 6 months of amenorrhea in menopausal age is considered as postmenopausal bleeding.
Even without amenorrhea or irregular bleeding if women over age of 52 yr. Continues to menstruate she needs investigations to rule out endometrial hyperplasia.

AETIOLOGY

1) Vulva =trauma, vulvitis,bening nd malignant lesions.
2)Vagina=foreign body,senile vaginitis,vaginal tumour,post radiation vaginitis
3)Cervix=cervical erosion,cervicitis,polyp,decubitus ulcer in prolapse,cervical malignancy.
4)Uterus=senile endometritis,tubercular endometritis,endometrial hyperplasia,polyp,endometrial ca.
5)DUB,metropathia haemorrhagica.6)fallopian tube malignancy.
7)Ovary=benign ovarian tumour.
8)hypertention,blood dyscrasia
9)Urinary tract=urethral caruncle,papilloma,ca. Of bladder.10)an imp. Reason for postmenopausal bleeding is indiscriminate/prolonged use of oestrogen unopposed by progestogens nd HRT when applied cyclicaly.

C/F=
History=age of menarche nd menopause history of taking oestrogen,prolapse.Abdominal pain nd foul smelling discharge r noticed in malignant tumours.

EXAMINATION
1)B.P.
2)General exam. obesity, DM.
3)abdominal palpation will reveal tumour.
4)speculum nd bimanual examination.

INVESTIGATIONS

1)blood count and smear will reveal blood dyscrasia.
2)blood sugar level
3)cervical cytology 4 cervical lesion.
4)endometrial study.
5)hysteroscopic inspection nd selective biopsy.
6)usg,ct,mri, transvaginal usg.
7)diagnostic laparascopy

MANAGEMENT

1)treat d cause.
2)When no cause is found and there has been 1 bout of bleeding pt. Should be kept under observation. If bleeding continues or recurre laparotomy is done..
Otherwise abdominal hysterectomy with bilateral salpingo-oophorectomy is done.