Postmenopausal bleeding: First steps in the workup
Is it endometrial cancer? When a postmenopausal woman presents with unexpected vaginal bleeding, this algorithm and review can help you answer that question without delay.
SIS is contraindicated in cases in which cancer cells were detected with either EMB or TVUS, as the procedure has been associated with a small but real risk of malignant cell dissemination.25
CASE Irene’s history did not reveal any significant risk factors for endometrial cancer. Physical exam revealed a cervical polyp. We obtained a Pap smear, which was normal, and removed the polyp, which was benign. Irene also underwent TVUS because of her low risk status. The test revealed an endometrial stripe of <4 mm and an endometrial polyp, prompting referral to a specialist.
The patient underwent a hysteroscopy and D&C. Her endometrial polyp was benign and the endometrial scrapings revealed atrophic squamous mucosa. Irene has had no further bleeding and is doing well at this time.
CORRESPONDENCE Danette B. Null, MD, 2411 Fox Hollow, Lake Charles, LA 70605; dnull@lcmh.com
