Type of publication:
Conference abstract
Author(s):
*Huda N.-U.; *Sahu B.
Citation:
BJOG: An International Journal of Obstetrics and Gynaecology. Conference: BGCS 2026 Book of Abstracts. Bristol United Kingdom. 133(Supplement 2) (pp S40), 2026. Date of Publication: 01 Jun 2026.
Abstract:
Background: Postmenopausal bleeding (PMB) occurs in 5-10% of women who are not on hormone replacement therapy (HRT). Around 90% of women diagnosed with endometrial cancer present with vaginal bleeding. National guidance and local Trust protocol PMB V6 recommend urgent referral and timely investigation to exclude malignancy. Early and effective triage is essential to meet the Faster Diagnosis Standard. Objective(s): To assess compliance with Trust PMB protocol V6 (November 2024) for the management of postmenopausal bleeding in women not on HRT, and to evaluate whether diagnosis was established within 28 days in line with the Faster Diagnosis Standard. Method(s): A retrospective audit was conducted of women not on HRT referred with PMB. Compliance was assessed against Trust standards, including triage, transvaginal ultrasound (TVS), endometrial thickness (ET) measurement, and appropriate use of hysteroscopy and biopsy. Outcomes were compared with protocol targets. Result(s): There was excellent compliance with diagnostic management in secondary care. Most women underwent timely TVS with accurate ET measurement, and those with ET >= 8 mm or additional risk factors appropriately proceeded to hysteroscopy. Women with thin endometrium were safely discharged without intervention. However, delays were identified in achieving diagnosis within 28 days. These were mainly due to delays in triage, investigations, review of results, and communication with patients. Conclusion(s): While diagnostic management of PMB showed strong compliance with Trust protocol, gaps were identified in meeting the Faster Diagnosis Standard. Separating HRT and non-HRT pathways, improving triage, and strengthening communication are essential to optimise resource use, improve patient experience, and ensure timely cancer exclusion.
DOI: 10.1111/1471-0528.70281
