Post‑menopausal bleeding (PMB) and endometrial cancer risk
Summary
- PMB = any vaginal bleeding occurring >12 months after the last menstrual period. It is a red‑flag symptom and should be investigated with a high index of suspicion for endometrial malignancy (NICE NG12).
- First‑line test is transvaginal ultrasound (TVUS). An endometrial thickness threshold of about 5 mm is commonly used in UK practice to guide further investigation; interpret in the clinical context (HRT, tamoxifen, obesity) and follow local pathways.
- Outpatient hysteroscopy with targeted endometrial biopsy is the preferred diagnostic test when imaging is abnormal or bleeding persists (NICE NG88).
Why this matters in ED/urgent care
- The ED/urgent clinic is frequently the first point of contact for women with PMB.
- Prompt triage, basic investigations and timely referral when indicated improve chances of early diagnosis and better outcomes.
Definition and risk factors
- Definition: any unexplained vaginal bleeding >12 months after the last menstrual period.
- Important risk factors:
- Increasing age
- Obesity
- Diabetes / insulin resistance
- Unopposed oestrogen therapy
- Tamoxifen
- Early menarche / late menopause (prolonged oestrogen exposure)
- Family history of endometrial or colorectal cancer (consider Lynch syndrome)