Postmenopausal bleeding

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Postmenopausal bleeding

  1. 1. Postmenopausal bleeding Aymen zemmal (10110068)
  2. 2. contents • SOEPEL. • Brief illustrate of terms related to menopause. • Menopause: age, pathophysiology, hormone level, anatomical changes, menopausal symptoms and treatment. • Postmenopausal bleeding: etiology, clinical features, diagnosis and investigations. • Management.
  3. 3. SOEPEL • Wadha is 54 years old saudi from oneiza is house wife and mother of 2 sons and 8 daughters. • Chief complain: vaginal bleeding, abdominal pain and diarrhea. • History of presenting illness: slight vaginal bleeding since 1 day, lower sudden moderate progressive abdominal pain not radiated since 1 day the diarrhea frequency is more than 10 time not associated with blood or mucus since yestreday. • Past history: medical: arthritis and right hand swelling. surgical: cessarian section and hysterectomy since months due to 2 kg fibroid uterus. OBG: menorrhagia. medications:
  4. 4. • Family history: no • Social history: healthy house wife and her husband is smoker. • Review of systems: GI: slight neasea, no fever, lower abdominal pain diarrhea.no weight loss and no vomit. OBG: menstrual history: menache 13 menopause: no just after hysterectomy. LMP:2 months. cycle length and frequency:28/6 postmenopausl bleeding: slight vaginal bleeding. postcoital bleeding.
  5. 5. • Discharge: yellowish slight not iching and no resh since 2 days. • Abdominal pain: bowel problems here diahrea is due to unheaten mild. dyspareunia prolapse Urinary symptoms: Obstetric history: 2 sons and 8 daughters got normal vaginal delivery except last one got cessarian section. contraceptions: Sex relationships: Infections:
  6. 6. SOEPEL • Object: GE: HR is 80. coulour, respiration is 18 term: 37. BP is 70/139. no alarm signs such abdominal examination especially palpation will reveal if there is a tumor. Gynae examination: speculum and bimanual examinations.
  7. 7. SOEPEL • Evaluation: DD: vulva: vulvitis, benign and malignant lesions and cancer. vaginal tumor: benign or malignant or foreign body.
  8. 8. SOEPEL • Plan: investigations and diagnostic techniques. CBC ultrasound laparscopy if ultrasound pick a pelvic tumor. biobsy. Learning goals: postmenopausal bleeding.
  9. 9. Important terms related to menopause • Perimenopause: is period of 3-4 years before menopause and followed by a year of amenorrhea. • Menopause: timed of cessation of ovarian function resulting in permenant amenorrhea. It take 12 months to confirm that it is menopause. • Late menopause: menstruation continues beyond 52 year sometimes it is normal due to healthy habits, and due to developed ovarian cancer or fibroid. • Postmenopausal bleeding: normaly after 1 year of amenorhea vaginal bleeding is occuring.
  10. 10. menopause • Occuring between 45-50 years average is 47 years. • It is difficult to see women after age of 50 menstruate well this delayed menopause could be due to good nutrition. • Menopausal age differences is not related to menarche race, socioeconomic status, number of pregnancies and lactation or usage of oral contraceptives. ( who agree?)
  11. 11. pathophysiology • Ovarian activity decline, initially ovulation fails so, no corpus luteum and no progesterone secreted in ovary. So, the premenopausal cycles are often anovulatory and irregular. • later, grafian follicle fails to develop estrogenic activity reduction and endometrial atrophy leads to amenorrhea. • Homones levels: 50% reduction in estrogenic production. 66% reduction in estrogen at menopause. E2, oestrone, FSH, androgens, testesterone, LH and androsternedione. :
  12. 12. Risk factors for menopause related diseases • • • • • • Early menopause. Surgical menopause. Chemotherapy especially alkalytic agents. Smoking, caffeine and alcohol. Family history of menopausal diseases. Drugs such GnRH, heparin, corticosteiroids, and clomphene(anti-estrogen)when given over prolonged period( anti estrgenic) can lead to estrogenic deficiency.
  13. 13. • Atrophy and regression of genital organs. • Menopausal symptoms: sudden cessation, gradual decrease of menses until to stop and gradual of length of cycle. • 60 to 70% without symptoms. • Hot flushes: waves of vasodilation affect face and neck last for 2-5 minutes each followed by severe sweating. • Irritability an lack of concentration. • Paresthesia.
  14. 14. • Libido changes. • Dysuria without infection. • Lately: arthritis, osteoporosis, cardiovascular, stroke, s kin changes, prolapse of genital tract. • Treatment HRT which protect against osteoporosis, cardiovascular symptoms, stroke, alzheimer disease and colonic cancer.
  15. 15. Postmenopausal bleeding • Normally 1 year of amenorrhea then vaginal bleeding occuring after 6 months of amenorrhea. • Etiology: vulva: trauma, vulvitis, benign and malignant lesions. Cervix: cervical erosion, cervicitis, polyp, decubitus, ulcer in prolapse and malignancy. Uterus: senile endometriosis, tubercular endometritis
  16. 16. • • • • • Ovary: Fallopian tube malignancy. Hypertension or anemia. Urinary tract Bowel problems
  17. 17. Clinical features • Abdominal pain. • Foul smelling discharge noticed in malignant tumors. • Bleeding painless. • Urinary and rectal symptoms.
  18. 18. Diagnosis and investigation • GE: vital signs and alarm signs. • Abdominal and gynacological examination. • Investigations: CBC, ultrasound, hysteroscopy, laparscopy and biobsy.
  19. 19. Management and treatment • Treat the cause first. • Patient should be kept under observation (warding).

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