Diagnosis details of 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. Postmenopausal bleeding is generally caused by the following reasons.

Postmenopausal bleeding caused by vaginal and cervical factors is generally not difficult to make a clear diagnosis through detailed medical history, gynecological examination, cervical cytology and histological examination. The causes of bleeding caused by uterine factors include benign lesions such as endometrial atrophy, endometritis, endometrial polyps, submucosal fibroids, endometrial hyperplasia and functional changes caused by hormone replacement therapy. Malignant lesions include endometrial cancer, uterine sarcoma, etc.

Postmenopausal bleeding caused by endogenous or exogenous estrogen. After menopause, the physiological function of the ovaries gradually declines, causing estrogen levels to drop, which cannot support the effective growth of the endometrium. However, the endometrium of postmenopausal women still responds to estrogen. After menopause, the ovarian stroma and adrenal cortex can secrete androgens, which are converted into estrone. Therefore, vaginal bleeding can occur when estrogen fluctuates. Similarly, bleeding can also occur when the endometrium is exposed to the effects of exogenous estrogen.

Malignant diseases: such as endometrial cancer, cervical adenocarcinoma, uterine sarcoma, ovarian malignancy, etc.

Bleeding caused by benign organic lesions: Common ones include endometritis, intrauterine contraceptive device, submucosal uterine fibroids, benign ovarian tumors, cervical polyps, urethral caruncle, senile vaginitis, etc.

Hysteroscopy. The diagnostic accuracy of fiber 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, fiber 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 by vaginal ultrasound is 5.5%, while the accuracy rate of positioning biopsy under fiber 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 fiber hysteroscopy can be observed and biopsied under direct vision; third, sometimes more than two biopsies are required to determine the extension of the tumor or lesion. Fiber hysteroscopy can be explored under direct vision and multiple biopsies can be performed; fourth, abnormal findings by vaginal ultrasound need to be confirmed by pathology, while fiber hysteroscopy can be directly biopsied.