Postmenopausal bleeding

[yalemd]

What is the next step in post.menopausal bleeding? Is it U/S or Endomet. sampling?

You know it is DDx for endometiral cancer. So to role it out do endomet.sampling. But some says better to start with U/S as if the enomet.strip thinkness less than 5 cm is less likely to be associated with cancerous changes and won't get you significant tissue on Bx.

Based on that what do you think it is better to go with fisrt?

Thanks

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[Xtrasystolic]

As far as USMLE is concerned:

Go for Endometrial sampling if >35yo, obese, has DM or HTN.

I'm not sure if an endometrial stripe <5mm is suggestive of benign changes. Atypia doesn't necessarily correlate to a higher degree of proliferation does it? (I'm wondering myself here, not questioning your view)

 

[OveractiveBrain]

Post Menopausal bleeding = endometrial sampling.

It should be one word in your mind "postmenopausalbleedingendometrialsampling"

It is likely to be NOT cancer (vaginal atrophy, trauma, etc) but you must absolutely rule out cancer. Any indication of cancer, be it CIN or full blown cancer, must be detected and treated.

 

[Fuzuli]

Post Menopausal bleeding = endometrial sampling.

It should be one word in your mind "postmenopausalbleedingendometrialsampling"

It is likely to be NOT cancer (vaginal atrophy, trauma, etc) but you must absolutely rule out cancer. Any indication of cancer, be it CIN or full blown cancer, must be detected and treated.

Endometrial status of a patient with postmenopausal bleeding must be evaluated, but the next step is not necessarily endometrial sampling. Both endometrial sampling and transvaginal ultrasonography (or sonohysterogram) can be used to evaluate the patient. According to ACOG: "Women with postmenopausal bleeding may be assessed initially with either endometrial biopsy or transvaginal ultrasonography;this initial evaluation does not require performance of both tests"

Source: http://www.ncbi.nlm.nih.gov/pubmed/19155921

 

[OveractiveBrain]

You know what doesnt count on Step 2? Current ACOG guidelines.

Do the sampling. SCore points on the test. When you roll into your OB/GYN residency, read the ACOG guidelines.

 

[Fuzuli]

You know what doesnt count on Step 2? Current ACOG guidelines.

Do the sampling. SCore points on the test. When you roll into your OB/GYN residency, read the ACOG guidelines.

Huh? I'm not saying people should go out their way to look for an ACOG guideline published 2 days ago, but this isn't like that. It's even in the Kaplan LN. I gave the PubMed link because it's free to access.

If a woman comes with PM bleeding for the first time and if vaginal U/S is among the choices, then there's no reason not to choose it. PM bleeding does not necessarily mean endometrial sampling.

 

[Knicks]

hmmmm, interesting 'debate' here.....