Postmenopausal Uterus (Postmenopausal Bleeding)

Postmenopausal Uterus (Postmenopausal Bleeding)

1. Introduction to Postmenopausal Uterus 100%

Definition: Cessation of menses ≥12 months
Common Clinical Concern: Postmenopausal Bleeding (PMB)
Role of Ultrasound: First-line modality
Screening for endometrial and adnexal pathology

2. Normal Postmenopausal Uterus Appearance 100%

Uterus: Small, atrophic, homogeneous
Endometrial Thickness: ≤4 mm in asymptomatic women
Cervix: May appear prominent compared to the uterus
No endometrial fluid or mass expected

3. Scanning Technique 100%

Transvaginal Ultrasound (TVS) – gold standard
Transabdominal Scan – used if TVS not feasible
Measurement of endometrial stripe in sagittal plane
Color Doppler to assess vascularity in lesions

4. Evaluation of Postmenopausal Bleeding 100%

Assess endometrial thickness (cutoff: 4–5 mm)
Identify focal lesions: polyps, fibroids, masses
Look for fluid collections, irregular endometrium
Evaluate ovaries for masses or cysts
Use saline infusion sonography (SIS) if needed

5. Common Pathologies Detected 100%

1. Benign Conditions

Endometrial Polyp
Submucosal Fibroid
Endometrial Hyperplasia (simple/complex)
Endometrial Atrophy (commonest cause of PMB)

2. Malignant or Suspicious

Endometrial Carcinoma (irregular, thickened stripe, >5 mm)
Cervical Cancer (distorted cervix, mass effect)
Ovarian Malignancy (complex masses)
Uterine Sarcoma (rare, aggressive masses)

6. Role of Doppler and SIS 80%

Doppler: Increased vascularity in malignancy
SIS: Enhances evaluation of polyps and fibroids
Useful in indeterminate or thickened endometrium
Helps plan hysteroscopic biopsy if needed

7. Management Guidance Based on US Findings 90%

Endometrial thickness ≤4 mm: Conservative follow-up
Thickness >5 mm or irregular: Further evaluation/biopsy
Focal lesions: Hysteroscopy or curettage
Persistent PMB: Always investigate thoroughly

8. Case Studies and Quiz Section 0%

Endometrial Polyp vs Carcinoma case
Ultrasound diagnosis of Atrophic Endometrium
Doppler pattern analysis in PMB
Quiz on normal vs abnormal postmenopausal uterus