Post menopausal bleeding

Introduction

The average age of menopause is fifty-one years. 

Menopause occurs when the ovaries cease making estrogen, and the patient is no longer ovulatory. 

The level of the follicle-stimulating hormone is elevated after menopause, as the hypothalamic-pituitary-ovarian axis attempts to stimulate ovulation despite the ovaries no longer being able. 

A woman is labeled menopausal if she has gone twelve months without menses.

After a woman is postmenopausal, further vaginal bleeding is no longer considered normal.

 Reasons :-

* Vaginal atrophy

*Endometrial atrophy

*Endometrial hyperplasia

*Tamoxifen or Hormone replacement therapy

*Uterine fibroid

*Uterine polyp

*Uterine , Cervical , Vaginal cancer

  fig. Cervical cancer

fig.endometrial adenoma

fig. Endometrial cancer

*Pelvic trauma

*Endometritis

*Infection

Clinical examination

P/S

P/V

TVS (transvaginal sonography )

PAP smear

Histeroscopy

Biopsy

Treatment and Management

*ATROPHY

Estrogen ointment

*ENDOMETRIAL HYPERPLACIA

D & C  

Endometrium biopsy

Progesterone support

*UTERINE FIBROID , POLYPS , CANCER

Surgical management

*infection

Use Antibiotics