Teaching Points
- Post Menopausal Bleeding (PMB) is defined as spontaneous vaginal bleeding which occurs more than one year after the date of the last menstrual period.
- For women on combined oestrogen/progesterone HRT, investigations are only warranted if the bleeding persists for > 6 months.
- Transvaginal Ultrasound is the initial imaging modality of choice. It can detect focal abnormalities of the endometrium, as well as measure the endometrial wall thickness which has been correlated with uterine pathology.
- Saline Infusion Sonohysterography involves infusing saline into the endometrial cavity followed by transvaginal ultrasound to improve visualisation of focal endometrial lesions.
- Further investigations may include a hysteroscopy and endometrial biopsy.
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