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Post-menopausal Bleeding (PMB)

What is it?
PMB is vaginal bleeding more than 12 months after the menopause. The concern is that it could originate from a growth inside the womb that could either be, or could become cancerous. For that reason women should always seek medical advice if such bleeding occurs; a woman will be seen in hospital within 2 weeks from referral.

What are the symptoms?
The bleeding could either be fresh or old in nature and variable in amount. Generally the loss is painless. It is possible to simply present with a persistent vaginal discharge.

What investigations might be required?
An internal examination will exclude a local cause of bleeding from the vulva, vagina or cervix. An ultrasound scan will visualise the uterus and ovaries. An important measurement is the thickness of the lining of the womb. If this is very thin, no further investigation may be required. However if the lining is thicker than expected, a hysteroscopy will be performed. This telescopic examination of the inside of the womb is generally performed in the out-patient department (OPD) and generally the investigation itself takes no more than a few minutes. It is usual to take a small biopsy of the lining at the end of the procedure. After 30 minutes and cup of tea a woman will be allowed home.

What treatments are available?
The results of the biopsy are usually available within the week. If the investigations are negative no further treatment is needed. If a polyp is found at hysteroscopy this will need removing either in the OPD or in main theatre under anaesthetic. If the biopsy finds a malignancy the patient will be referred into the oncology unit at the Royal Hallamshire Hospital for further treatment.

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