Post- Menopausal and Abnormal Uterine Bleeding – Diagnosis and Management

Abnormal uterine bleeding is one of the most common presentations in gynaecology. Transvaginal ultrasound (TVS) with colour Doppler is the cornerstone of initial management. TVS, in experienced hands, can reliably exclude the most common intra-cavitary pathologies including endometrial polyps and submucosal fibroids. Their exclusion, in pre-menopausal women,
aids in the diagnosis of dysfunctional uterine bleeding. In postmenopausal women, the endometrial thickness reliably selects those who need further testing. If a thin and regular endometrium is visualized, malignancy is most unlikely. To allow for reliable evaluation of the endometrium, TVS has to be performed before endometrial sampling. Saline-infusion sonohysterography (SIS) is most valuable in the detection of focal intra-cavitary lesions. TVS with
or without SIS can provide enough information to avoid an unnecessary hysteroscopy. An evidence-based algorithm for the work-up of women with postmenopausal bleeding will also be discussed.

A/Prof George Condous from Omni Gynaecological Care. 

Supported by Bayer Schering