Definitions & Basics
Define postmenopausal bleeding
What is any vaginal bleeding occuring after 12 months of menopause?
Hyperplastic growths of the endometrial glands
What are Polyps?
Additional menstrual history
What is age at menopause? and why is this important?
First-line test for people with increased endometrial cancer risk or recurrent PMB
What is an endometrial biopsy?
In postmenopausal patients, uterine bleeding is usually ___ and self-limited, and treatment is usually _______ once endometrial carcinoma (or premalignant histology) has been excluded.
What is Light and Unnecessary?
The cardinal sign of endometrial carcinoma is __________.
Hypoestrogenic changes following menopause that is the second most common cause.
What is Genitouriary Syndrome of Menopause?
Previous menstrual patterns
What is history of irregular cycles, heavy bleeding, or known endometrial conditions?
First-line imaging to assess endometrial thickness (ET) and uterine abnormalities
What is a Transvaginal Ultrasound?
Persistent bleeding can be a sign of _________ even in the setting of a benign endometrial biopsy or TVUS.
What is Endometrial Cancer?
All postmenopausal people with unanticipated PMB should be evaluated for ____________.
What is Endometrial Hyperplasia/Carcinoma?
The most concerning cause and one that should be evaluated urgently
What is Endometrial Carcinoma?
Name the primary exams that need to be performed for this patient.
What is a pelvic and abdominal exam?
Labs you would order for this patient
What are CBC, TSH, and PT/aPTT?
If recurrent bleeding, refer to Gynecologist for possible ________ w/ hysteroscopy if indicated.
What is dilation and curettage?
Name the bleeding pattern for postmenopausal bleeding. ****
What is light spotting to heavy bleeding that is often unpredictable?
Medications or Hx of structural abnormalities that are risk factors for AUB in Menopause
Meds:
What is Tamoxifen, HRT ( unopposed estrogen)
Structurally:
What are Uterine or Cervical Polyps
Name the signs of _____ that would indicate PMB
(2 signs)
What is anemia? What are hypotension and tachycardia?
The differential diagnosis for this patient
What are endometrial polyps, GSM, and Endometrial Carcinoma?
Removes polyps or thickened areas of the uterine lining caused by hyperplasia
What is a Hysteroscopy?
Thickening of the uterine lining, sometimes with abnormal cells that can lead to cancer
What is Endometrial Hyperplasia?
Because endometrial polyps express this _______, growth of the polpys can be stimulated by this ______ therapy.
What is Estropgen and Progesterone &
Estrogen Therapy
Name additional information we should know about gynecological and medical history
What is the History of polyps, fibroids, or endometrial hyperplasia? What is the History of gynecologic surgeries such as hysterectomy or endometrial ablation.
Most likely diagnosis and risk factors that predispose her to this
What are Genitourinary Syndrome of Menopause?
RF: Age, report of vaginal bleeding and vaginal dryness
Complete removal of the uterus is recommended for cases of endometrial or cervical cancer or severe hyperplasia.
What is a Hysterectomy?