ORIGINAL ARTICLE   

Minerva Ginecologica 2020 April;72(2):64-9

DOI: 10.23736/S0026-4784.20.04432-9

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Recurrent postmenopausal bleeding: a survey of practice among gynecologists in Scotland

Marwa M. ALLAM ¹, Mohammed S. ALLAM ², Mohamed K. MEHASSEB ³ ✉

¹ Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK; ² Department of Obstetrics and Gynecology, University Hospital of Wishaw, Wishaw, UK; ³ Department of Gynecological Oncology, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK

BACKGROUND: The definition and management of recurrent postmenopausal bleeding (PMB) are not well described in the literature, with no consensus among the clinicians and no available contemporary UK evidence-based guidelines. We conducted this survey to examine the practice of gynecologists based in Scotland in relation to recurrent postmenopausal bleeding.
METHODS: A web-based questionnaire was sent to 200 non-training grade gynecologists in Scotland exploring their views on the definition, investigation and management of recurrent PMB. Data were extracted from the 61 responses received.
RESULTS: Seventy-seven percent of responders defined recurrent PMB as two or more episodes of PMB, while 21% defined it after three episodes. A bleed-free interval of 3 and 6 months was needed to identify a recurrence by 46% and 44% of responders, respectively. 70% would investigate recurrent PMB with a combination of transvaginal sonography, hysteroscopy and biopsy. Only 19% would arrange a pelvic MRI routinely, while 43% would never offer one. 72% would consider a hysterectomy at some stage, with 22% of responders offering it after 3 episodes of PMB with negative investigation. 18% would never offer a hysterectomy without an identified pathology. 32% of responders felt that the management of recurrent PMB required an individualized case-by-case approach.
CONCLUSIONS: This survey highlights the need for a clinical guideline to address the wide variation in the management of recurrent PMB.

KEY WORDS: Postmenopausal bleeding; Hysteroscopy; Menopause; Ultrasound; Hysterectomy