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Important: please update your RDS app to version 4.7.3 Details with newsletter below.

Please update your RDS app to v4.7.3

We asked you in January to update to v4.7.2.  After the deployment planned for 27th February, this new update will be needed to ensure that you are able to download RDS toolkits even when the RDS website is not available. We will wait until as many users as possible have downloaded the new version before switching off the old system for app downloads and moving entirely to the new approach.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. 

To update to the latest release:

 On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Right Decision Service newsletter: February 2025

Welcome to the February 2025 update from the RDS team

1.     Next release of RDS

 

A new release of RDS is planned (subject to outcomes of current testing) for week beginning 24th February. This will deliver:

 

  • Fixes to mitigate the recurring glitches with the RDS admin area and the occasional brief user interface outages which have arisen following implementation of the new distributed technology infrastructure in December 2024.

 

  • Capability to embed content from Google calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream into RDS pages.

 

  • Capability to include simple multiplication in RDS calculators.

 

The release will also incorporate a number of small fixes, including:

  • Exporting of form within Medicines Sick Day Guidance in polypharmacy toolkit
  • Links to redundant content appearing in search in some RDS toolkits
  • Inclusion of accordion headers alongside accordion text in search result snippets.
  • Feedback form on mobile app.
  • Internal links on mobile app version of benzo tapering tool

 

We will let you know when the date and time for the new release are confirmed.

 

2.     New RDS developments

There is now the capability to publish toolkits on the web with left hand side navigation rather than tiles on the homepage. To use this feature, turn on the “Toggle navigation panel” option at the top of the Page settings menu at toolkit homepage level – see below. Please note that publication to downloadable mobile app for this type of navigation is still under development.

The Benzodiazepine tapering tool (https://rightdecisions.scot.nhs.uk/benzotapering) is now available as part of the RDS toolkit for the national benzodiazepine prescribing guidance developed by the Scottish Government Effective Prescribing team. The tool uses this national guidance developed with a wide-ranging multidisciplinary group. This should be used in combination with professional judgement and an understanding of the needs of the individual patient.

3.     Archiving and version control and new RDS Search and Browse interface

Due to the intensive work Tactuum has had to undertake on the new technology infrastructure has pushed back the delivery dates again and some new requirements have come out of the recent user acceptance testing. It now looks likely to be an April release for the search and browse interface. The archiving and version control functionality may be released earlier. We’ll keep you posted.

4.     Statistics

At the end of January, Olivia completed the generation of the latest set of usage statistics for all RDS toolkits. If you would like a copy of the stats for your toolkit, please contact Olivia.graham@nhs.scot .

 

5.     Review of content past its review date

We have now generated reports of all RDS toolkit content that has exceeded its review date by 6 months or more. We will be in touch later this month with toolkit owners and editors to agree the plan for updating or withdrawing out of date content.

 

6.     Toolkits in development

Some important toolkits in development by the RDS team include:

  • National CVD prevention pathways – due for release end of March 2025.
  • National respiratory pathways, optimal cancer diagnostic pathways and cancer prehabilitation pathways from the Centre for Sustainable Delivery. We will shortly start work on the national cancer referral pathways, first version due for release via RDS around end of June 2025.
  • HIS Quality of Care Review toolkit – currently in final stages of quality assurance.

 

The RDS team and other information scientists in HIS have also been producing evidence summaries for the Scottish Government Realistic Medicine team, to inform development of national guidance around Procedures of Limited Clinical Value. This guidance will in due course be translated into an RDS toolkit.

 

7. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

  • Friday 28th February 12-1 pm
  • Tuesday 11th March 4-5 pm

 

To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)

 

To invite colleagues to sign up to receive this newsletter, please signpost them to the registration form  - also available in End-user and Provider sections of the RDS Learning and Support area.   If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot  If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.

With kind regards

 

Right Decision Service team

Healthcare Improvement Scotland

 

 

Postmenopausal bleeding (486)

Please report any inaccuracies or issues with this guideline using our online form

Post menopausal Bleeding (PMB) is defined as unscheduled bleeding after one year of amenorrhoea. Women with this symptom are at increased risk of endometrial cancer and require urgent assessment. 

Referral

Patients with PMB should be seen within 2 weeks of referral to allow compliance with the 62 day National Guideline on cancer treatment times. To facilitate this all PMB referrals should be upgraded to ‘Urgent’ when letters are vetted. Where possible, patients should be assessed at a dedicated PMB/ one-stop clinic.

History

A full medical history is required including smear history. Particular attention should also be paid to drug history including HRT use, current or past tamoxifen use and use of anticoagulants such as warfarin, heparin and clopidogrel which many women take for cardiac problems.

Examination

All women with PMB should undergo speculum and bimanual pelvic examination. This can be facilitated by use of a virgin speculum. Patients should have an EUA if, despite these measures, examination proves impossible

Investigation

The initial investigation of choice is the measurement of endometrial thickness by transvaginal ultrasound scan. Endometrial biopsy is reserved for those women whose endometrial thickness exceeds a specified cut-off as follows:

  • Group 1: Women who have never used any HRT OR have not used HRT for more than one year OR are using continuous combined HRT.

Endometrial biopsy is required if the endometrial thickness exceeds 3mm.

  • Group 2: Women who are using sequential HRT OR have done so in the past year.

Endometrial biopsy is required if the endometrial thickness exceeds 5mm.

If the histology report in either group states ‘insufficient tissue for analysis’ and the ET has been thickened then the patient should have a hysteroscopy, if this hasn’t already been done, and a repeat biopsy.

  • Group 3:  Women who are current users of tamoxifen.

Tamoxifen is associated with distortion of the endometrial architecture.

Consequently, ultrasonography is a poor means of detecting endometrial cancer in this group. All such women should undergo hysteroscopy and endometrial biopsy.

Other Issues

  • This guideline refers to women who present with PMB for the first time. Those with recurrent symptoms after 6 months should be re-investigated, and women with persistent bleeding within 6 months of initial investigation should undergo hysteroscopy and endometrial biopsy.

  • There is no published evidence regarding the assessment of PMB in women taking Selective Estrogen Receptor Modifiers (SERMs) other than tamoxifen, eg Raloxifene. It is recommended that the precautionary principle applies and these women be treated in the same way as those taking tamoxifen i.e. undergo hysteroscopy and endometrial biopsy.

  • Transabdominal ultrasound scan may be used as a complementary investigation e.g. if the uterus is particularly enlarged or a wider view of the abdomen is required. It may also be used in the assessment of the small number of women in whom transvaginal scanning is technically impossible.

  • There is no evidence to support the use of endometrial thickness measurements and the associated cut-offs in the assessment of women with peri-menopausal bleeding. These women should undergo clinical evaluation as per menstrual disorder patients.

  • If an IUS or IUCD is in situ, patients should undergo transvaginal scan and biopsy. The coil may be left in place but will compromise the validity of ET measurements (hence the need for biopsy).

  • Endometrial biopsy is also required if:
    • there is an incomplete/poor view on ultrasound i.e the endometrial stripe is not seen along its length.
    • there is fluid within the endometrial cavity.
    • there is irregularity of the endometrial echo, regardless of the ET measurement. These women should also undergo hysteroscopy.

The preceding version of this GG&C guideline referenced SIGN guideline No.61 – The Investigation of Postmenopausal Bleeding (2002). This was withdrawn in February 2015. In the absence of any current national guidance, this revised version refers to current good practice standards. 

Editorial Information

Last reviewed: 14/07/2022

Next review date: 14/07/2025

Author(s): Morton Hair.

Version: 4

Approved By: Gynaecology Clinical Governance Group

Document Id: 486