Should a gynaecologist examine me for postmenopausal bleeding before ultrasound?

[Alicay]

Had 3 days of PMB/cramps & wasnt able to see GP on Monday so saw a private gynae today (Wed). He said he wasn't concerned and booked me in for an ultrasound in 2 weeks. He didn't physically examine me at all and I'm really concerned that he didn't - surely he should be checking the pelvis for lumps and bumps/doing an internal? I actually offered and he said no! I've had a polyp before which was seen on physical exam. Can't decide whether this guy is not doing what he should be so to try again with the GP. PMB is a red flag symptom for cancer....

I've had a scan for this before and IIRC didn't have an exam first. Hope all is well . Are you on HRT? According to my gynaecologist the most common cause of PMB is women forgetting their progesterone.

I had an exam after the scan.

The transvaginal scan is the best way to see what is going on. A doctor feeling about with gloved fingers is not.

I have had PMB multiple times, always trans vaginal scan, no physical exam.
And yes, it is a symptom of cancer BUT the vast, vast majority of instances of PMB are NOT because of cancer. It just needs to be ruled out.

An examination will not give you any information that a scan will not. On the other hand a scan will give you a lot of information that a PV exam will not. It’s common not to examine if an ultrasound will be necessary whatever it shows.

OK thanks all, that's reassuring. I have spent hours & hours on the internet scaring myself and it's come on the back of several other health things. It's just the vaginal exam seemed to be very much on the protocol of first things to do and have always had one before.

i’m a GP - i always examine !
I look at the cervix to check it is normal and check I can’t see a polyp poking out cervix.
I also do a cervical smear.

Actually someone needs to visualise the cervix to see if that's looking normal in case bleeding is coming from there so you should have had a speculum examination included as part of the workup. When we did referrals for the urgent uss they wanted the examination findings too.

We wouldn't be allowed to send a smear if it wasn't due as it's classed as a screening test....which is funny when they don't look at the cervical cells on a smear unless it's HPV positive.

I didn't want to be examined ehen i had unexplained bleeding.

An ultrasound is much more efficient way of diagnosing issues.

Can't see carcinoma of the cervix on an ultrasound. I agree it's a far superior examination than bimanual but the guidance GPs and medical students are taught for PMB is to visualise the cervix. You'd look pretty stupid if you missed it and don't think my defence union would be very happy. @LunaTheCatand I were obviously taught the same. The amount of medical misinformation on this site is scary.

And then what would the next thread be "useless GP missed cancer of cervix as they didn't examine me properly when I had PMB" we really can't win.

Thanks Musicaltheatremum .. I have diagnosed a cancer cervix on speculum exam 😟 .. it was horrendous.
OP please don’t be frightened..in 30 plus yrs GP, seeing several woman a week with post menopausal bleeding , I have only seen cancer cervix and maybe 2-3 uterine cancers..it is usually benign… and your instinct is right.. the gynae should have examined you .. you cou;d go back GP, make an appointment with another gynae. Best wodhes.

My experience is the same as @LunaTheCat. Very little pathology found and I have had PMB twice myself. But yes get yourself examined.

Our trust would offer a transvaginal scan as standard, even if it hadn't been requested with the pelvic uss. So I wouldn't be concerned about not being examined by the gp.

But with a transvaginal scan you don't see the cervix fully. You need to physically shine a light on it and examine it properly....so she needs a proper examination. Goodness the advice on here is awful.

I didn't offer advice .

You said you wouldn't be concerned about not being examined by the GP. Well I would be very concerned so in that way you were suggesting they shouldn't be worried about it. As a GP with 30+ years experience your statement is wrong.

I was referring not just to the advice that had been offered but the comments that are just simply dangerous.

I didn't have an exam first either. The nurse who was in the room said PMB is usually hormones.

My mother was referred for a scan, examined after the scan and then next steps followed.

It is , but it's the presenting sign of endometrial carcinoma or some other genital tract malignancy so whilst I tell my patients not to worry if does rarely come back as a malignancy so it has to be taken seriously.

I qualified in 1986 , I was a GP from 1992 to 2023. I have huge amounts of experience as has the other GP who commented on here. I really worry about the dumbing down of medicine. It's hard, you need a 6th sense. You need to know enough about every system in the body to avoid missing something and this thread and others that quote so much rubbish really scare me about the future of medicine.

I've had 2 episodes of PMB and have been examined both times and I always examined every patient who presented to me with it. Not always before I did the referral although it got more difficult to refer if you hadn't done the examination bug I did look at them.

As far as I can see, the medics on this thread offered advice whilst the non medics (myself included) relayed their personal experience. Both useful / valid info IMO.

I can only comment on my own experience of PMB but in each case my GP examined me in the surgery before making referrals for pelvic and transvaginal USS, plus the 2WW gynae. Am currently waiting for my 3rd hysteroscopy under GA due to thickened endometrium.

Please can someone tell me what PMB is? I have taken myself to A&E tonight because I of heavy bleeding, cramps, clots. Otherwise healthy 45yr old, 3 DCS, no health issues ever.

*Sorry to jump on your thread @Alicay

I think it was more earlier on (first couple of posts)people were saying an ultrasound is fine you don't need examined and we were trying to say the OP should go back and be examined by a GP....by examined I mean speculum examination.