Is there a need to investigate vaginal bleeding after the menopause?

Is there a need to investigate posmenopausal bleeding?

Postmenopausal vaginal bleeding must always be investigated. In the majority of cases no serious problem will be found but there are times when the bleeding is the first symptom of serious disease including cancer. Even when the bleeding is related to cancer, if it is diagnosed early there is a very good chance that the disease can be cured (Q32.2).

Before the advent of ultrasound, a D and C was always performed. Nowadays if ultrasound shows no obvious abnormality and it is less than 5mm thick, no further investigation is usually required.

Ten per cent of women with ultrasound evidence of a thin endometrium, less than 5mm, will have further bleeding and ten per cent of these will have endometrial cancer ie 1 in 100 women with recurrent bleeding after a negative ultrasound.⁰⁸⁰¹

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