Abnormal Bleeding – post menopausal

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1 Background Information / Scope of Pathway

These pathways were developed to guide clinicians when managing abnormal bleeding in post-menopausal patients
The pathways are not provider specific and so the guidance and forms apply to all providers.

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2 Information Resources for Patients and Carers

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3 Development and Updates to this Pathway

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4 Referral Forms

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5 Take history

  • When was HRT started?
  • LMP before HRT was started?
  • Bleeding pattern before HRT was started?
  • Check for irregular intermenstrual bleeding or post coital bleeding before HRT was started.
  • Ask about HRT tablets
  • History suggestive of malabsorption or history of malabsorption.
  • History suggestive of gastrointestinal upset

Consider Non-HRT causes of bleeding:

  • Possibility of pregnancy – use of contraceptive where appropriate
  • Sexual history ?STI
  • Date of last smear

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8 Examination

Vulva, vagina and cervix visualised, bimanual performed.
If suspect cancer refer as appropriate
If cervical polyp found don’t assume polyp is the cause of the bleeding. Refer to asymptomatic polyp pathway

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16 Advise patient to stop taking HRT

Advise patient to stop taking HRT for 4 – 6 weeks to check if bleeding related to HRT to prevent patient from undergoing unnecessary investigations