Management of Postmenopausal Bleeding

Aim: To describe the appropriate management of women with postmenopausal bleeding (PMB). Study Design: Descriptive study in one year (Jan – Dec, 2012). Method: All patients with postmenopausal bleeding in one year were investigated and managed. Basic investigation was trans-vaginal sonography. Those with endometrial thickness more than 4 mm were further investigated by dilatation and curettage, then management strategy was planned according to the cause. Result: A total of 23 patients were presented with postmenopausal bleeding (endometrial thickness > 4 mm) during one year. Among them 11 case were having first episode and the remaining had recurrent bleeding. Endometrial hyperplasia (simple) was the common pathology (52%), in whom surgical management (hysterectomy) was performed in 60% cases. Three cases (13%) were managed with MIRENA (levonorgestrel releasing intrauterine system). Two case were diagnosed as endometrial carcinoma. Both of them were having advanced stage and were referred to Shaukat Khanum Hospital Lahore. Conclusion: Trans-vaginal sonography can reliably asses thickness and morphology of endometrium, thus risk group can be identified. Endometrial hyperplasia is the major cause of PMB. Dilatation and curettage, can provide sufficient diagnostic accuracy. Hysterectomy remained the main management of PMB patients.