Postmenopausal bleeding

Abstract

Postmenopausal bleeding (PMB) is a symptom of possible gynaecological malignancy. According to present guidelines, women presenting with this symptom should be referred urgently to a team specializing in the management of gynaecological cancer, and be seen within two weeks of referral. Examination and investigation of these women should be able to exclude malignancy, while being acceptable to the patient and cost-effective. The gold standard modality of investigation to visualize the uterine cavity is hysteroscopy, but transvaginal scanning is recommended as the first-line investigation to select those who need further diagnostic evaluation. Hysteroscopy should be performed in women with a thickened endometrium on scan and women with recurrent episodes of bleeding despite negative scan findings. There have been very few studies that have examined women's knowledge, attitudes or concerns about PMB or its assessment. Further research would inform information and support strategies for women presenting and undergoing assessment for this symptom.