{"id":4328,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/postmenopausalbleeding\/"},"modified":"2026-04-10T08:26:28","modified_gmt":"2026-04-10T07:26:28","slug":"postmenopausalbleeding","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gynaecology\/postmenopausalbleeding\/","title":{"rendered":"Post Menopausal Bleeding (No HRT)"},"content":{"rendered":"\n<p>The Scottish Cancer Referral Guidelines have been updated and went live on Wednesday, 6th August\u00a02025.<br>We are working hard to update all relevant information on the RefHelp website. If you would like to see the guidelines please click here\u00a0 <a href=\"https:\/\/www.gov.scot\/publications\/scottish-referral-guidelines-suspected-cancer-2025\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.gov.scot\/publications\/scottish-referral-guidelines-suspected-cancer-2025\/\u00a0<\/a><\/p>\n\n\n\n<p><strong><strong>For patients on HRT, please see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/unscheduled-bleeding-on-hrt\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/unscheduled-bleeding-on-hrt\/\" target=\"_blank\" rel=\"noreferrer noopener\">Unscheduled Bleeding on HRT<\/a><\/strong><\/strong><\/p>\n\n\n\n<p><\/p>\n\n\n\n<div data-wp-interactive=\"core\/file\" class=\"wp-block-file\"><object data-wp-bind--hidden=\"!state.hasPdfPreview\" hidden class=\"wp-block-file__embed\" data=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/PMB-2026-with-link-RefHelp-FINAL.pdf\" type=\"application\/pdf\" style=\"width:100%;height:600px\" aria-label=\"Embed of PMB 2026 RefHelp FINAL.\"><\/object><a id=\"wp-block-file--media-4ea1d4ff-3b1d-45b5-9615-b9ffb00831c9\" href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/PMB-2026-with-link-RefHelp-FINAL.pdf\">PMB 2026 RefHelp FINAL<\/a><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/PMB-2026-with-link-RefHelp-FINAL.pdf\" class=\"wp-block-file__button wp-element-button\" download aria-describedby=\"wp-block-file--media-4ea1d4ff-3b1d-45b5-9615-b9ffb00831c9\">Download<\/a><\/div>\n\n\n\n<p><strong>Thrombocytosis is a risk marker for malignancy. This especially applies to the \u2018LEGO-C\u2019 group \u2013 Lung, Endometrial, Gastric, Oesophageal and Colorectal cancer. See <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/haematology\/thrombocytosis\/\" target=\"_blank\" rel=\"noreferrer noopener\">Thrombocytosis \u2013 RefHelp<\/a>&nbsp;for more information.<\/strong><\/p>\n\n\n\n<p><strong>MM &amp; RC 22\/1\/26<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<p>Patients with Post-Menopausal Vaginal Bleeding and:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Clinical examination suggests vulval\/vaginal\/cervical malignancy<\/li>\n\n\n\n<li>Currently using Tamoxifen or have used it in the past<\/li>\n\n\n\n<li>Lynch or Cowden Syndrome<\/li>\n\n\n\n<li>BRCA1 or BRCA2 carriers without bilateral salpingo-oophrectomy<\/li>\n\n\n\n<li>Pelvic USS with endometrial thickness (\u22655.0mm): we now ask all clinicians to send an onward referral to Gynaecology (RIE&gt;Gynaecology&gt;PMB abnormal scan result)<\/li>\n\n\n\n<li>Pelvic USS where a copper IUCD present or Progesterone IUCD present for &gt;5 years<\/li>\n\n\n\n<li>Pelvic USS with ovarian pathology (see&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/ovariancyst\/\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>ovarian cyst<\/strong><\/a>&nbsp;and&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/Pages\/OvarianCancer.aspx\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>ovarian cancer<\/strong><\/a>&nbsp;pathway)<\/li>\n\n\n\n<li>Second or subsequent episode(s) of PMB, more than 6 months since reassuring prior assessment (even if endometrium &lt;5.0mm on prior Pelvic USS)B.<\/li>\n<\/ul>\n\n\n\n<p>For patients on HRT, please see <strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/unscheduled-bleeding-on-hrt\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/unscheduled-bleeding-on-hrt\/\" target=\"_blank\" rel=\"noreferrer noopener\">Unscheduled Bleeding on HRT<\/a><\/strong>.<\/p>\n\n\n\n<p>There are 2 situations, as below, where patients who are, or have recently been, on HRT should be referred for a PMB USS (not an Unscheduled Bleeding on HRT USS):<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Ongoing unscheduled bleeding after a total of 12 months of HRT despite troubleshooting actions (<strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/unscheduled-bleeding-on-hrt\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/unscheduled-bleeding-on-hrt\/\" target=\"_blank\" rel=\"noreferrer noopener\">Unscheduled Bleeding on HRT<\/a>)<\/strong><\/li>\n\n\n\n<li>Ongoing bleeding at 6 weeks since stopping HRT (<strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/unscheduled-bleeding-on-hrt\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/unscheduled-bleeding-on-hrt\/\" target=\"_blank\" rel=\"noreferrer noopener\">Unscheduled Bleeding on HRT<\/a><\/strong>)<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Women with PMB, normal clinical examination and endometrial thickness less than 5.0mm, in the absence of focal pathology e.g. polyp.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<p><strong>1. For patients with PMB<\/strong><\/p>\n\n\n\n<p>Refer to Radiology for PMB USS <mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">Sci-Gateway &gt; ELCH\/LB\/RIE\/SJH &gt; Clinical Radiology &gt; LI PMB (No HRT)<\/mark><\/p>\n\n\n\n<p><strong>If the USS report is reported as abnormal (ET \u22655mm) Primary Care Clinician to refer patient to Gynaecology<\/strong><\/p>\n\n\n\n<p><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">Sci-Gateway &gt; RIE &gt; Gynaecology &gt; LI PMB Abnormal Ultrasound<\/mark><\/p>\n\n\n\n<p><strong>Where the USS is reported as abnormal (ET \u22655mm)&nbsp;<\/strong>the report will be emailed by radiology to the Clinical Inbox of the referring GP practice and will require the Primary Care Clinician to&nbsp;<strong>inform the patient and to send a USOC SCI Gateway referral.&nbsp;<\/strong>It will also be emailed to the Gynaecology cancer clinic.&nbsp;<\/p>\n\n\n\n<p><strong>2. For patients with PMB on tamoxifen<\/strong><\/p>\n\n\n\n<p class=\"has-alert-red-color has-text-color\"><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-standard-black-color\">USOC Referral Gynaecology <\/mark><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">Sci-gateway &gt; RIE &gt; Gynaecology &gt; LI Basic sign referral (select priority USOC)<\/mark><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-standard-black-color\"> and simultaneous referral to Radiology for PMB USS <\/mark><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">Sci-Gateway &gt; ELCH\/LB\/RIE\/SJH &gt; Clinical Radiology &gt; LI PMB (No HRT)<\/mark><\/p>\n\n\n\n<p class=\"has-alert-red-color has-text-color\"><strong><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-standard-black-color\">3.For suspected vulval, vaginal, cervical malignancy:<\/mark><\/strong><\/p>\n\n\n\n<p class=\"has-alert-red-color has-text-color\"><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-standard-black-color\">USOC Referral Gynaecology<\/mark> Sci-Gateway &gt; RIE&gt; Gynaecology&gt; LI Basic sign referral (select priority USOC)<\/p>\n\n\n\n<p class=\"has-alert-red-color has-text-color\"><strong><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-standard-black-color\">4.For recurrent\/persistent PMB:<\/mark><\/strong><\/p>\n\n\n\n<p class=\"has-alert-red-color has-text-color\"><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-standard-black-color\">USOC Referral Gynaecology<\/mark> Sci-gateway &gt; RIE &gt; Gynaecology &gt; LI Basic sign referral (select priority USOC) <mark style=\"background-color:#ffffff\" class=\"has-inline-color has-standard-black-color\">and simultaneous referral to Radiology for PMB USS<\/mark> Sci-Gateway &gt; ELCH\/LB\/RIE\/SJH &gt; Clinical Radiology &gt; LI PMB (No HRT)<\/p>\n\n\n\n<p class=\"has-alert-red-color has-text-color\"><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-standard-black-color\">5.For patients with ongoing unscheduled bleeding after a total of 12 months of HRT despite troubleshooting actions <strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/unscheduled-bleeding-on-hrt\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/unscheduled-bleeding-on-hrt\/\" target=\"_blank\" rel=\"noreferrer noopener\">Unscheduled Bleeding on HRT<\/a><\/strong>:<\/mark><\/p>\n\n\n\n<p class=\"has-alert-red-color has-text-color\"><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-standard-black-color\">USOC Referral Gynaecology<\/mark> Sci-gateway &gt; RIE &gt; Gynaecology &gt; LI Basic sign referral (select priority USOC) <mark style=\"background-color:#ffffff\" class=\"has-inline-color has-standard-black-color\">and simultaneous referral to Radiology for PMB USS <\/mark>Sci-Gateway &gt; ELCH\/LB\/RIE\/SJH &gt; Clinical Radiology &gt; LI PMB (No HRT)<\/p>\n\n\n\n<p class=\"has-alert-red-color has-text-color\"><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-standard-black-color\"><strong>6.For patients with ongoing bleeding at 6 weeks since stopping <\/strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/unscheduled-bleeding-on-hrt\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/unscheduled-bleeding-on-hrt\/\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>HRT<\/strong> <strong>Unscheduled Bleeding on HRT<\/strong><\/a><strong> link:<\/strong><\/mark><\/p>\n\n\n\n<p class=\"has-alert-red-color has-text-color\"><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-standard-black-color\">USOC Referral Gynaecology<\/mark> Sci-gateway &gt; RIE &gt; Gynaecology &gt; LI Basic sign referral (select priority USOC) <mark style=\"background-color:#ffffff\" class=\"has-inline-color has-standard-black-color\">and simultaneous referral to Radiology for PMB USS<\/mark> Sci-Gateway &gt; ELCH\/LB\/RIE\/SJH &gt; Clinical Radiology &gt; LI PMB (No HRT)<\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>The Scottish Cancer Referral Guidelines have been updated and went live on Wednesday, 6th August&nbsp;2025.We are working hard to update all relevant information on the RefHelp website. If you would like to see the guidelines please click here&nbsp; https:\/\/www.gov.scot\/publications\/scottish-referral-guidelines-suspected-cancer-2025\/&nbsp; For patients on HRT, please see Unscheduled Bleeding on HRT Thrombocytosis is a risk marker for<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3976,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[236],"class_list":["post-4328","page","type-page","status-publish","hentry","category-post-menopausal-bleeding"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/gynaecology\/post-menopausal-bleeding\/\" rel=\"tag\">Post Menopausal Bleeding<\/a>","rttpg_excerpt":"The Scottish Cancer Referral Guidelines have been updated and went live on Wednesday, 6th August&nbsp;2025.We are working hard to update all relevant information on the RefHelp website. If you would like to see the guidelines please click here&nbsp; https:\/\/www.gov.scot\/publications\/scottish-referral-guidelines-suspected-cancer-2025\/&nbsp; For patients on HRT, please see Unscheduled Bleeding on HRT Thrombocytosis is a risk marker for","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4328","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=4328"}],"version-history":[{"count":27,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4328\/revisions"}],"predecessor-version":[{"id":27601,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4328\/revisions\/27601"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3976"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=4328"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=4328"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}