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Assessment of post menopausal bleeding

Authoring team

General points are listed below:

History:

  • last menstrual period?
  • bleeding
    • like a period?
    • associated with intercourse?
    • previous episodes?
  • vaginal discharge
    • any features suggestive of infection?
  • last cervical smear
  • drug history
    • on HRT that is not designed to have cyclical bleeding?
    • previous use of oral contraceptive pill?
  • obstetric history
    • nulliparity associated with endometrial carcinoma
  • functional enquiry - any recent unexplained weight loss, loss of appetite

Examination:

  • abdominal examination
  • speculum examination - smears if indicated from history or examination
  • vaginal examination - assessment of uterus size and consistency

Investigation:

  • in general a hysteroscopy is indicated

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