What tests should be done for postmenopausal bleeding

Generally, women who have stopped menstruating for more than one year after the age of 50 are called menopausal. Vaginal bleeding after menopause is called postmenopausal bleeding. So, what tests should be done for postmenopausal bleeding? Below, we will introduce what tests should be done for postmenopausal bleeding.

1. Hysteroscopy The diagnostic accuracy of fiberoptic hysteroscopy is higher than that of TVS. TVS may miss local hyperplastic lesions and adenocarcinoma. Even the endometrial findings detected by TVS and SHSG need to be directly biopsied under hysteroscopy. Therefore, fiberoptic hysteroscopy is better than vaginal ultrasound for the examination of lesions of perimenopausal and postmenopausal uterine bleeding. There are four reasons: First, the thickness of the double-layer endometrium without hormone treatment is <4mm. The misdiagnosis rate of abnormal endometrium in vaginal ultrasound is 5.5%, while the accuracy of positioning biopsy under fiberoptic hysteroscopy is higher than 94%; second, the early stages of endometrial hyperplasia and endometrial adenocarcinoma are both focal, which are easily missed by vaginal ultrasound, while fiberoptic hysteroscopy can be observed and biopsied under direct vision; third, sometimes more than two biopsies are required to determine the extension range of the tumor or lesion. Fiberoptic hysteroscopy can be explored under direct vision and multiple biopsies can be performed; fourth, abnormal findings on vaginal ultrasound need to be confirmed by pathology, while fiberoptic hysteroscopy can be directly biopsied.

2. TVs is a non-invasive examination method often used to screen the causes of postmenopausal uterine bleeding. Karlsson studied PMB in which TVS showed no abnormalities, endometrium ≤4nnn, and laparoscopy found 1 small endometrial polyp; 39 cases of endometrium>4mm, TVS suggested endometrial abnormalities, hysteroscopy only confirmed 35 cases, 4 false positives; 9 cases of endometrium ≥8mm, hysteroscopy showed 8 cases of endometrial polyps, 1 case of endometrial polyps or submucosal myoma. Taking pathological findings as the final diagnosis, the sensitivity, specificity, positive predictive value and negative predictive value of TVS were 100%, 75%, 90%, 100% respectively, and the corresponding hysteroscopy was 97%, 88%, 94%, 93%. Therefore, it is believed that TVS screening can be performed before laparoscopy. O'Connell et al. reported that the results of TVS and hysteroscopic biopsy were consistent with surgery by >90%, the sensitivity of TVS was 94%, the specificity was 96%, and no endometrial hyperplasia or cancer was missed. They believed that this method was a reliable tool for outpatient evaluation of PMB. Granberg believed that TVS could be used as the first step in routine examinations for evaluating PMB. When ultrasound images were abnormal or uncertain, or when ultrasound images were normal but the patient continued to have symptoms, hysteroscopy must be applied, and further endoscopic biopsy should be performed to exclude or show pathological conditions.