Basic examination items for postmenopausal bleeding

Some patients with postmenopausal bleeding, especially elderly patients, often do not understand the examinations prescribed by doctors. Of course, postmenopausal bleeding is often caused by benign diseases such as senile vaginitis and endometritis, but cervical cancer, endometrial cancer, and ovarian tumors need to be ruled out, so the corresponding examinations are cervical cytology and gynecological B-ultrasound examinations.

1. Hysteroscopic examination: 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 focal in the early stages of endometrial hyperplasia and endometrial adenocarcinoma, which are easy to be 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: It is a non-invasive examination method often used to screen the causes of postmenopausal uterine bleeding. This method is a reliable tool for outpatient evaluation of PMB. Granberg believes that TVS can be used as the first step in the routine examination of PMB. When the ultrasound image is abnormal or uncertain, or when the ultrasound image is normal but the patient continues to have symptoms, hysteroscopy must be used, and further endoscopic biopsy must be performed to exclude or show pathological conditions.

Reminder again: Postmenopausal bleeding requires the exclusion of the possibility of malignant tumors. Do not just seek two doses of Chinese medicine, but investigate the cause to prevent missed diagnosis of malignant tumors.