Assistant professor Wassan Nori 20222023 Causes of PMB Management History Examination Blood work Ultrasound examination Endomaterial sampling andor hysteroscopy Patients age and age of menopause ID: 1047067
Download Presentation The PPT/PDF document "Post-menopausal bleeding" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
1.
2. Post-menopausal bleeding Assistant professor Wassan Nori 2022-2023
3.
4.
5. Causes of PMB
6.
7. Management History Examination Blood work Ultrasound examination Endo-material sampling and/or hysteroscopy
8. • Patients’ age and age of menopause risk of endometrial CA increased by increasing age. Parity as nulliparity increases risk while multiparity protects against endometrial CA Bleeding history: duration and severity of the bleeding and whether it was related to intercourse. Associated symptoms pain, fever, or changes in bladder or bowel function • risk factors for genital tract malignancy. smear history and whether previous abnormal cervical cytology. family history of colorectal, endometrial, or other cancers associated with hereditary non-polyposis colorectal cancer.
9. • past medical and surgical history including diabetes which rises endometrial CA risk through elevated estrogen levels and hyperinsulinemia. History of PCOS due to chronic unopposed estrogen stimulation. History of hypothyroidism. • A drug history: topical estrogen administration provoke endometrial proliferation. women taking tamoxifen for breast cancer have higher risks of endometrial cancer or current use of anticoagulant drugs which might provoke PMB. History of COCP is protective against developing endometrial CA.
10. Examination Including general examination, for cachexia, , pallor, obesity and thyroid gland assessment, All women presenting with PMB should undergo a full abdominal and pelvic examination to assess the patient for any obvious masses or lymphadenopathy.
11. Bimanual examination size, position and mobility of the uterus, as well as assessing for any adnexal pathology. Speculum examination should also be performed, direct inspection can reveal pathologies such as cervical carcinoma, cervical polyps, ectropion of the cervix, or vaginal atrophy. A cervical smear test should be taken if necessary, according to the National Screening Programme, as well as vaginal swabs if any abnormal discharge is detected.A digital rectal examination (PR) ensure that bleeding is in fact of gynecological origin as per vagina (PV) bleeding can sometimes be confused with hematuria or per rectum (PR) bleeding.
12.
13. Ultrasound scan non-invasive diagnostic test determine which women should undergo hysteroscopy and endometrial biopsy. Any case with PMB should be referred to as urgent TVUS, and reviewed within 2 weeks.We use TVUS for Greater resolution and better visualization compared to abdominal ultrasound; it improves the detection of endometrial cancer and other endometrial abnormalities. however, it does not give a histological diagnosis.A thickened endometrium (ET greater than 4 mm), indicates an increased risk of malignancy or other pelvic pathology, the thicker the endometrium, the higher is of endometrial cancer. so an urgent investigation is needed.A thin endometrium (ET less than 4 mm) is normal in postmenopausal women. The risk of finding endometrial cancer in (ET) of less than is 1:900.
14.
15.
16.
17.
18.
19.
20. TreatmentOnce malignancy has been excluded and a benign diagnosis is established, the patient can be reassured. Hospital admission may be needed should the blood loss is severe for restoration of lost blood and correction of vital parameters
21.
22.
23.
24.
25. Thank you for attention