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... thanks is a poor substitute for the way you have used your considerable skills ... I will always think of you with great respect and a certain humility... please extend our thanks and gratitude to your team and secretary.

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Postmenopausal bleeding

In women, menopause is said to have occurred when there have not been any menstrual periods for 12 months. It can be associated with symptoms such as hot-flushes, poor concentration, poor memory, poor sleep, tiredness, and dry vagina.

Vaginal bleeding that occurs after the menopause is NOT normal and advice should always be sought from a doctor. The commonest cause for postmenopausal vaginal bleeding is often related to HRT and under these circumstances it is often not due to anything sinister but this should always be discussed with a doctor as a change in HRT could solve the problem if the doctor is satisfied that nothing sinister is underlying it.

Postmenopausal bleeding can be associated with a cancer of the womb or cervix or vagina in about 10 to 20% of cases. Cancers of the ovary do not usually cause vaginal bleeding.

At the consultation, a smear will be carried out if there hasn't been a recent one. A biopsy may be taken from the womb lining which can be slightly uncomfortable but most women tolerate it adequately. The procedure lasts less than a minute. A pelvic ultrasound scan is carried out to check the thickness of the womb lining. This takes less than 5 minutes. I do this scan myself as part of the same examination and hence avoiding any delays and further visits (if a recent scan has already been done elsewhere then it is not repeated). If the womb lining is thickened on scan then a hysteroscopy (a telescope examination) will be recommended. This is because a thickened womb lining is more likely to harbour a cancer or a polyp.

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