Management of women with postmenopausal bleeding: evidence‐based review

Key content Patients with postmenopausal bleeding (PMB) have a 10–15% chance of having endometrial carcinoma; they should therefore be seen within 2 weeks of referral. Cervical and vulval cancers remain important components of the differential diagnosis and can only be assessed by clinical examination. There are well-developed and evidence-based strategies on how best to investigate women with PMB. These strategies are formulated in several guidelines. Learning objectives To understand that the completion of investigations of patients with PMB should include test performance and patient characteristics. To be able to evaluate the various investigations for women with PMB. To be able to describe the appropriate management of women with PMB on tamoxifen, and unscheduled PMB in women undergoing hormone replacement therapy. Ethical issues Incidental finding of thickened endometrium on transvaginal sonography (TVS) in asymptomatic individuals carries a management dilemma. Approach to benign pathology: should subsequent evaluation for benign abnormalities be performed after malignancy has been ruled out? Ongoing work and technology development will evolve our strategy in managing PMB.