I have had some postmenopausal bleeding (PMB). What will the gynaecologist want to do?

I have had some postmenopausal bleeding (PMB). What will the gynaecologist want to do?

Postmenopausal bleeding is defined as vaginal bleeding occurring after 12 months of amenorrhoea (no period), in a woman of the age where the menopause can be expected.

If you have had postmenopausal bleeding (PMB), your gynaecologist will want to take a full history (story), and a general and gynaecological examination will be carefully performed. This allows your gynaecologist to exclude disease of the lower genital tract and also to check for any swellings in the pelvis. Your gynaecologist will also need to exclude disease within the cavity of the uterus, notably a tumour and possibly endometrial cancer. Until quite recently, if the uterus was still present, a “D and C” (hysteroscopy D and C) was mandatory. These days, ultrasound examination (pelvic ultrasound), particularly using a vaginal or rectal probe, will often exclude serious problems within the pelvis. Research conducted in several hospitals in London, including my own (Whipps Cross University Hospital), demonstrated that when the lining of the uterus appeared healthy and was less than 5mm thick and all the lining could be clearly seen there was never any serious problem within the uterus. If these criteria are not fulfilled we would always wish to proceed to hysteroscopy and D and C (hysteroscopy D and C).

The importance of early assessment by your doctor of postmenopausal bleeding cannot be overemphasised. In the 10% where malignancy is the culprit, the prognosis is usually very good if it is treatment starts early.

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