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  • Print publication year: 2009
  • Online publication date: February 2014

4 - Postmenopausal bleeding: presentation and investigation


This chapter reviews evidence on various investigative modalities and management planning for women presenting to the gynaecology clinic with post-menopausal bleeding. It discusses some of the issues to be considered when planning a cost-effective, clinic-based service for these women. Dilatation and curettage (D&C) was for many years the investigation of choice in women presenting with post-menopausal bleeding. The Pipelle de Cornier is a widely used system. The system is a narrow plastic catheter, which is passed through the cervical canal into the uterine cavity. Transvaginal ultrasound (TVS) is an accurate, non-invasive diagnostic modality that enables examination of the uterine cavity and endometrium in the outpatient setting. With the uterus visualised in a longitudinal plane, the thickness of the endometrial echo can be measured. Endometrial polyps are a common finding in post-menopausal women and when they occur in association with post-menopausal bleeding they should be removed for histopathological diagnosis.

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