Menopausal Problems & Geriatric Gynecology

  • Vaginal bleeding in postmenopausal women is the most common presenting symptom of endometrial cancer. Evaluation with transvaginal ultrasound or endometrial biopsy is necessary but can be accomplished on an outpatient basis in stable, reliable patients. If an endometrial stripe of 4 mm or less is observed with ultrasound imaging performed in an emergency department, patients do not need further evaluation of the endometrial.  Menopause is a physiologic process marked by the cessation of ovarian function and menstrual periods. Hormone replacement therapy (HRT), especially when initiated close to the start of menopause and continued at the lowest possible dose for the shortest duration possible, has less risk than believed previously. Pelvic organ prolapse (POP) affects millions of women in the United States and contributes to poor body image and difficulty with urinary, gastrointestinal, and sexual function. Treatment options include Kegel exercises, pessaries, and surgery.

VAGINAL BLEEDING IN THE POSTMENOPAUSAL PATIENT Vaginal bleeding in premenopausal women is a common patient presentation in emergency departments. When assessing postmenopausal women, an emergency physician’s typical patterns of thought regarding gynecologic conditions must be expanded. Postmenopausal bleeding is most commonly defined as vaginal bleeding after a period of no menses for at least 1 year.

1 The physiology of normal menses is contingent on ovulatory cycles, which are marked by endometrial proliferation and secretion and, then, in the absence of pregnancy, a predictable menstrual period after estrogen and progesterone withdrawal.

2 The transition to menopause is often marked by sporadic anovulatory cycles, during which unopposed estrogen stimulates the endometrium and the absence of progesterone results in unpredictable endometrial sloughing and vaginal bleeding.