Postmenopausal Bleeding-Endoscopic Management

Abstract

Postmenopausal bleeding (PMB) is defined as any vaginal bleeding that occurs after 12 month duration of amenorrhoea that has occurred due to menopause. Any vaginal bleeding that occurs after 6 months of amenorrhea from presumed menopause should be treated as “suspect” and the cause of bleeding investigated and identified. A single episode of postmenopausal bleeding of any amount ranging from mere spotting of brownish discharge to heavy bleeding is abnormal and should be assessed. Postmenopausal bleeding is a common symptom and endometrial cancer needs to be excluded though most cases prove to be benign or inconsequential. This article provides an insight into the various causes of postmenopausal bleeding and the role of hysteroscopy for the exclusion of endometrial pathology. A stepwise approach enables accurate diagnosis in women with postmenopausal bleeding. Transvaginal ultrasound with color Doppler can diagnose submucus fibroids, polyps and inhomogenous endometrium. Recently, the authors have used the hysteroscope for the exclusion of cervical pathologies in women with abnormal Pap smears and suspicious cervices. The development of laparoscopic surgery to its current status wherein the most complex procedures can be performed laparoscopically today has completely changed the connotations of surgery in the modern world including that of many cancer surgeries. The laparoscopic route has made an entry into the arena of oncosurgery for its obvious benefits and greater patient satisfaction in those units where gynae-onco-surgeons are also trained laparoscopic surgeons. Its safety and decreased morbidity along with similar longterm outcomes has led to the increased use of the laparoscopic lymphadenectomy and laparoscopic/vaginal radical hysterectomy. The advantages of laparoscopic management of endometrial cancer is that it usually has a similar or a shorter operating time, improves with surgical experience of the operating surgeon, shorter hospitalization period, less blood loss and similar financial cost, though sometimes the costs may be higher from use of disposable instruments. Laparoscopy is feasible even in obese women. It results in improved quality of life. Moreoever, the lower peri-operative morbidity with similar or better yield of pelvic and para aortic lymph nodes, similar or less complications and similar recurrence free survival are obvious endearing benefits of the laparoscopic approach.