BLEEDING AFTER THE MENOPAUSE

OMNI evaluates women with bleeding after menopause also known as post-menopausal bleeding.

A woman is considered to be menopausal when a year has passed since her last period. Any bleeding after this time is always considered to be potentially abnormal. In fact only a small proportion of women who bleed after the menopause have anything significantly wrong.

However, on occasion bleeding after menopause can be a sign of pre-cancerous changes or even cancers. One form of cancer that bleeding after menopause can be symptomatic of is endometrial cancer. This form of cancer is a growth of abnormal cells in the lining of the uterus (endometrium). Endometrial cancer is also known as uterine cancer and most often occurs in women over the age of 50.

With this in mind it is important that bleeding after the menopause is investigated thoroughly.

Once oestrogen levels drop after the menopause the skin of the vagina becomes thinner, and bleeding may result from this. Problems with the cervix may also be a causative factor. So any assessment must include a cervical smear, which will mean that the skin of the vagina will be examined as part of this procedure.

The role of ultrasound

Bleeding may also come from the lining of the womb or endometrial cavity. Normally the lining is very thin as there is little oestrogen circulating to stimulate it. This lining can be measured using ultrasound, furthermore any other problems in the cavity of the uterus (womb) can also be seen. There are many studies that show that if the lining of the uterus is thin (< 5mm), then it is very unlikely that there is anything significantly wrong.

In this way ultrasound can be used to reduce the need for unnecessary and more intrusive investigation. If the endometrial thickness is increased, then Saline Infusion Sonohysterography (SIS) will exclude intra-cavitary focal lesions such as endometrial polyps. In the absence of focal endometrial pathology, a small sample of the womb lining needs to be examined in order to exclude problems (taking a biopsy). This can be carried out as an outpatient procedure in some cases, but may require an examination under a brief general anaesthetic. Importantly, most women with post-menopausal bleeding do not have anything seriously wrong.

In this way ultrasound can be used to reduce the need for unnecessary and more intrusive investigation. If the endometrial thickness is increased, then Saline Infusion Sonohysterography (SIS) will exclude intra-cavitary focal lesions such as endometrial polyps. In the absence of focal endometrial pathology, a small sample of the womb lining needs to be examined in order to exclude problems (taking a biopsy). This can be carried out as an outpatient procedure in some cases, but may require an examination under a brief general anaesthetic. Importantly, most women with post-menopausal bleeding do not have anything seriously wrong.

OMNI Ultrasound & Gynaecological Care

Condous performs Advanced Endosurgery procedures for women needing intervention for pelvic masses, adnexal pathology, severe endometriosis or hysterectomy. He also runs ‘Hands on’ Live Sheep Laparoscopic Workshops for gynaecologists at Camden Veterinarian School.
Having completed an undergraduate degree with the University of Adelaide, he left Australia in 1993 and moved to London where he completed his training in Obstetrics and Gynaecology. From 2001 to 2003 Condous worked as a Senior Research Fellow at St George’s Hospital, London. At St George’s he set up the Acute Gynaecology Unit, the first in the United Kingdom. It was also during this time that he developed an interest in Early Pregnancy and especially the management of pregnancies of unknown location (PULs). Condous has developed many mathematical models for the prediction of outcome of PULs which have been featured in numerous peer review journals. In 2005, he returned to Australia where he completed his Laparoscopic Fellowship at the Centre for Advanced Reproductive Endosurgery, Royal North Shore, Sydney.

Condous was appointed as a Consultant Gynaecologist and Senior Lecturer at Nepean Hospital in 2006 and soon was made Associate Professor. In 2010, he was made Departmental Head of Obstetrics and Gynaecology at Nepean Hospital. He obtained the MRCOG in 1999 and was made FRANZCOG in 2005. In 2009, he was awarded his Doctorate in Medicine (MD), University of London, for his thesis entitled: “The management of pregnancies of unknown location and the development of new mathematical models to predict outcome”.

Condous has edited three books including the “Handbook of Early Pregnancy Care”, published over 100 papers in international journals and is internationally renowned for his work in Early Pregnancy. He is the Associate Editor for Gynaecologic Obstetric Investigation, which is a European based journal, as well as the Australasian Journal of Ultrasound in Medicine (AJUM). He is on the organising committee and is an invited speaker at the International Society of Ultrasound in Obstetrics and Gynaecology (ISUOG) Scientific meeting in Sydney 2013. His current research interests relate to the management of ectopic pregnancy, 1st trimester growth, PULs and miscarriage and the use of transvaginal ultrasound (in particular sonovaginography, to predict posterior compartment deep infiltrating rectovaginal endometriosis).Condous is also actively involved with post-graduate education including the annual running of the Early Pregnancy and Gynaecological Ultrasound Interactive Courses for Sonologists, Radiologists, Sonographers and Gynaecologists in Australia.