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This Concept Map, created with IHMC CmapTools, has information related to: Postmenopausal Bleeding, Post-Menopausal Bleeding 10-25% w/ uterine malignancy Endometrial Causes Endometrial Atrophy MOST COMMON 60-80%, Post-Menopausal Bleeding 10-25% w/ uterine malignancy Endometrial Causes Endometrial CA 10-15% MOST CONCERNING -mostly adenoCA -most common GYN CA -bleeding in 90% -postmenopausal -meno/metrorrhagia -abnl PAP in 1-5% (ASGUS), Endometrial CA 10-15% MOST CONCERNING -mostly adenoCA -most common GYN CA -bleeding in 90% -postmenopausal -meno/metrorrhagia -abnl PAP in 1-5% (ASGUS) Px Related to 1. Grade 2. Depth of invasion, Endometrial CA 10-15% MOST CONCERNING -mostly adenoCA -most common GYN CA -bleeding in 90% -postmenopausal -meno/metrorrhagia -abnl PAP in 1-5% (ASGUS) Etiology Unopposed Estrogen -Exogenous -PCOS -Liver disease -Estrogen producing tumors Previous radiation, Post-Menopausal Bleeding 10-25% w/ uterine malignancy Vaginal Causes Atrophic Vaginitis, Post-Menopausal Bleeding 10-25% w/ uterine malignancy Cervical Causes Cervical CA -do PAP smear, Endometrial CA 10-15% MOST CONCERNING -mostly adenoCA -most common GYN CA -bleeding in 90% -postmenopausal -meno/metrorrhagia -abnl PAP in 1-5% (ASGUS) Dx Biopsy - in-office sampling -in ALL post-meno, ᡛyo w/ abnl bleeding Pap smear Endocervical Curettage Hysteroscopy if insuff sample U/S (ɱmm endometrium is ABNL), Post-Menopausal Bleeding 10-25% w/ uterine malignancy Endometrial Causes Fibroids, Post-Menopausal Bleeding 10-25% w/ uterine malignancy Iatrogenic HRT-15-25%, Endometrial CA 10-15% MOST CONCERNING -mostly adenoCA -most common GYN CA -bleeding in 90% -postmenopausal -meno/metrorrhagia -abnl PAP in 1-5% (ASGUS) Tx Staging: TAH BSO +/- Nodes Washings CXR Adjuvant Stage I-II: XRT III-IV: Progestin, radiation, CTX, Post-Menopausal Bleeding 10-25% w/ uterine malignancy Endometrial Causes Endometrial Hyperplasia 5-10% -Simple: Cystic hyperplasia w/out atypia 1-2%->CA -Complex: Adenomatous w/o atypia Tx: Progesterone for both -10-14d q month -Atypical: simple or complex w/ cytologic atypia 29%->CA (mean 10yr) Tx: Hyst (simple), CA w/u (complex), Endometrial CA 10-15% MOST CONCERNING -mostly adenoCA -most common GYN CA -bleeding in 90% -postmenopausal -meno/metrorrhagia -abnl PAP in 1-5% (ASGUS) Subtypes Endometrioid - 75-80% Papillary serous: Poor Px -no elevated estrogen -in Af. Americans -Acts like OV CA -Late presentation Sarcomas GRADES I-well-diff ɝ% solid II-mod 5-50% solid III-porly ᡪ% solid, Endometrial CA 10-15% MOST CONCERNING -mostly adenoCA -most common GYN CA -bleeding in 90% -postmenopausal -meno/metrorrhagia -abnl PAP in 1-5% (ASGUS) Risk Factors Obesity Early menarche/Late meno Nulliparity PCOS Anovulation DM HTN Endometrial Hyperplasia TAMOXIFEN Risk x2-3 Family Hx, Post-Menopausal Bleeding 10-25% w/ uterine malignancy Endometrial Causes Endometrial Polyps 2-12% ɝ% ->malignancy