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Oxford University Hospitals NHS Foundation Trust

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Post Menopausal Bleeding / Hysteroscopy Clinic referrals

Postmenopausal bleeding (PMB) is any vaginal bleeding that occurs more than twelve months after periods have stopped in a woman of menopausal age. It may apply to younger women with premature menopause.

It is a common problem, but needs investigation in order to eliminate endometrial (lining of the womb) cancer as a cause of the bleed. Most women with PMB do not have endometrial cancer.

Risk factors for endometrial cancer include:

  • estrogen treatment
  • Tamoxifen treatment (after breast cancer)
  • polycystic ovary disease
  • hereditary non-polyposis colorectal carcinoma
  • obesity
  • diabetes.

Using the combined oral contraceptive pill decreases the risk.

Other causes of PMB include:

  • vaginal atrophy
  • benign endometrial hyperplasia
  • benign polyps
  • cervical, vulval or vaginal cancer.

Cautions: although most women investigated for PMB will not have endometrial cancer, this must be assumed until proven otherwise.

PMB in women on HRT still needs investigation. An obvious lesion like atrophic vaginitis does not exclude another lesion. Many women are unable to distinguish between vaginal and urinary bleeding and some are unable to distinguish rectal bleeding.

All women with PMB should be referred for assessment within two weeks.

All women with PMB should be referred by their GP for an urgent transvaginal ultrasound with a request for within two weeks and clearly marked as PMB.

They will then be sent an appointment for the ultrasound. Depending on the ultrasound result, either an urgent appointment in the Hysteroscopy Clinic or a General Gynaecology Clinic will then be offered.

For more information on post menopausal bleeding please visit:

Clinic details

The Hysterescopy Clinic is held twice a week Monday and Thursday in the Diagnostic Suite on Level 1 at the John Radcliffe Hospital Women's Centre.

The service is led by Consultant in Gynaecology Mr Vic Rai and his team.

Women are able to have a full assessment with consultation plus hysteroscopy and biopsy (under local anaesthetic) if necessary. Some women will need to come back to the hospital at a later date to have a further assessment with a hysteroscopy under general anaesthetic.

Women will receive biopsy results within two weeks, usually in Mr Rai's Friday morning outpatient clinic, or by letter.

Abnormal results are always dealt with in person in clinic. If the result does show cancer, then the Gynaecological Oncology MDT will take over all the care.

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