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A table summarising suggested actions when a woman presents with post-menopausal bleeding: This table should be used in conjunction with NICE guidance on suspected endometrial carcinoma. Please also refer to our chart on endometrial cancer when assessing a woman with suspected PMB and seek advice / discuss- when in doubt.
| Criteria and Considerations | Risk Factors and Additional Information | History and Examination | Clinic |
|---|---|---|---|
| Any woman with bleeding after attaining menopause (12 months of natural amenorrhea) | Risk factors: obesity, unopposed oestrogen, HRT, tamoxifen, T2DM, hypertension | - Assess duration of symptoms - Inquire about LMP (Last -Menstrual Period) Gather smear and HRT history - Ask about anticoagulant use, co-morbidities, mobility issues - Include speculum and vaginal examination findings | PMB Clinic (2-week rule) |
| Persistent bleeding on HRT | PMB Clinic (2-week rule) | ||
| Unexplained PMB 6 weeks after stopping HRT | PMB Clinic (2-week rule) | ||
| Unscheduled bleeding on sequential HRT after 3 months | PMB Clinic (2-week rule) | ||
| Unscheduled bleeding on continuous combined HRT after 6 months* | PMB Clinic (2-week rule) | ||
| Women on tamoxifen | Increased risk | PMB Clinic (2-week rule) | |
| Women using Mirena or progesterone-only pill (POP) | - Consider FSH measurement if the menopausal status is unknown - Remove coil/stop POP if appropriate - No referral required if... |
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