This document discusses postmenopausal bleeding and provides information about menopause. It defines key terms like menopause, pathophysiology of menopause, and risk factors. It then describes postmenopausal bleeding including potential causes, clinical features, diagnosis, and management. Investigations for postmenopausal bleeding may include ultrasound, hysteroscopy, laparoscopy, and biopsy. Treatment involves addressing the underlying cause and patients may need to be observed during treatment.

1. Postmenopausal bleeding
Aymen zemmal (10110068)

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. 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. • 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. • 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. 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. SOEPEL
• Evaluation: DD:
vulva: vulvitis, benign and malignant lesions and
cancer.
vaginal tumor: benign or malignant or foreign body.

8. SOEPEL
• Plan: investigations and diagnostic techniques.
CBC
ultrasound
laparscopy if ultrasound pick a pelvic tumor.
biobsy.
Learning goals:
postmenopausal bleeding.

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.

12. 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?)

13. 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.
:

14. 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.

15. • 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.

16. • 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.

17. 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

18. •
•
•
•
•
Ovary:
Fallopian tube malignancy.
Hypertension or anemia.
Urinary tract
Bowel problems

19. Clinical features
• Abdominal pain.
• Foul smelling discharge noticed in malignant
tumors.
• Bleeding painless.
• Urinary and rectal symptoms.

20. Diagnosis and investigation
• GE: vital signs and alarm signs.
• Abdominal and gynacological examination.
• Investigations:
CBC, ultrasound, hysteroscopy, laparscopy and
biobsy.

21. Management and treatment
• Treat the cause first.
• Patient should be kept under observation
(warding).