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....

Post menopausal bleeding. Defined as bleeding after a year with no periods. Hope you get sorted. At your age if you still have a regularish cycle it will be defined as dysfunctional uterine bleeding. Both need looking into.

I’d want to do a visual examination of the cervix, take swabs and refer for scan.

I wouldn’t be able to do a smear unless it was actually due or overdue, as the lab would reject it. It’s a screening tool, not a diagnostic tool.

(Not a GP, just an ANP).

I didn't see the GP at all. I phoned the GP and asked to be referred on the 2 week pathway which they did. I had a scan and then afterwards a physical exam then an MRI I had a large cyst which was removed 18 months later -yes,I waited that long,it was awful!

Have filled out a form with GP practice - asking for advice and will go with what they say. Really persuaded now I should have had an exam.

Having been down a similar path, I adopt a belt and breeches approach, so definitely chase up for an examination. I had postmenopausal bleeding, an exam and then an ‘abnormal’ transvaginal/trans abdominal scan which put me on the two week suspected cancer pathway. Polyp removed and biopsy was clear, ovarian cysts coming and going but simple and a medium sized fibroid.
My GP was supposed to request a CA125 blood test before the biopsy (said on the notes) but it wasn’t done, however I have the NHS app and went into the surgery and made sure they did it. Things do get overlooked, so it’s good to advocate for yourself like you are.

The internal ultrasound is the key investigation- to see if the lining of the uterus is abnormally thickened

I hope @Alicay you won't mind jumping on here, as I am currently being investigated for exactly the same thing at the moment.

May I ask the experts on here what are the usual, non-scary, reasons for PMB?

But you still need to visualise the cervix to exclude pathology there.

So yes she needs examining!

Endometrial cancer is not the only cause of post menopausal bleeding. A scan will exclude that but won't exclude a cervical cause.

@Alicay Did the consultant ask about your smear tests- when the last one was done, etc? They won't have access to your NHS medical records if you saw them privately. I agree with other posters that, although a scan is required, you should also have been asked about smear tests and if you would consent to an examination to see if you had anything like a cervical polyp or some other (likely) benign condition.

We don't know how long it is since your last period, your age, if you're on HRT or not. The consultant could have made a decision based on all of those, In women under 50 a period can appear some time later (and be normal) but nevertheless a quick look should have been part of the consultation.