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Pre/Post Menopausal Vaginal Bleeding

Megan Jones, MD and Neda Frayha, MD
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Tags emergency medicine EM · OB Gyn Obstetrics and Gynecology

Vaginal bleeding - an Ob/Gyn concern, right? Not so fast. Turns out, we can handle quite a bit of this in primary care. Neda and Dr. Megan Jones dive into diagnosis and management of bleeding in both the pre and post-menopausal woman. 

 

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Ian L., Dr -

Is one vaginal ultrasound for post menopausal bleeding sensitive and specific enough for the 5mm cut off .?

Neda F., MD -

Hi Ian. Here's Dr. Jones' response: "Yes a transvaginal ultrasound looking at endometrial thickness (<5mm) is very sensitive & specific for a non-invasive measure to rule out hyperplasia/CA in a postmenopausal woman. If the thickness is <5mm, then atrophy is most likely & this can be treated with local estrogen. If >5mm, then biopsy is warranted.

If recurrent vag bleeding onsets with repeat vag ultrasound showing endometrial thickness <5mm then further investigation would be warranted to eval if a polyp or focal area of hyperplasia/CA is present. This would be more invasive with endometrial biopsy or hysteroscopy/D&C."

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Primary Care RAP Written Summary April 2020 1 MB - PDF

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