5 things your GP will ask before a referral to an OBGYN

Women who experience vaginal bleeding after menopause will visit their GP due to menstruation when they are no longer supposed to be menstruating. We call this post-menopausal bleeding.

Here are 5 key questions your GP will ask you before referring you to a specialist

    1. Is the blood loss only from your vagina? You might find this an awkward question, but this is to make sure to rule out any rectal blood loss which could look and feel like blood coming from the vagina. Especially if the woman is known to have haemorrhoids, it is a topic that your GP will want to briefly touch on and move on to the next question
    2. The 3 How’s: How does the vaginal blood loss occur, How often does it occur a day/week and How long does it last for? 
    3. Does vaginal blood loss occur during or after sexual intercourse? If this is the case, the GP will need to determine whether it is a cervical polyp or the lining of the vagina that is wearing thin and after friction bleeds easily. This is also known as vaginal atrophy. 
    4. Do you use any medication?
    5. Could you possibly be at risk of a sexually transmitted infection? May sound strange that your GP asks you this for vaginal blood loss, however diseases like chlamydia can cause similar symptoms. 

Things you must ask your GP during your consultation

What are the chances that even after I have been referred to a specialist, I will be sent back to my GP for further treatment? 

50% of the women who have post-menopausal bleeding and are referred to a specialist do not have any serious underlying medical conditions. In the majority of the cases, the blood loss is due to vaginal atrophy. 

Do I have endometrial cancer with these symptoms?

Endometrial cancer is known to cause post-menopausal bleeding. It occurs in about 2000 women per year in the Netherlands and  20% (400 women) of these women will unfortunately die from this disease. In the majority of cases, when endometrial cancer is detected  and treated early, just over 90% of women will make a full recovery.

Should my GP perform a PAP smear even if I’ve had one just recently?

Yes. For any woman with a new onset of post-menopausal bleeding,  regardless of the results of an old PAP smear, a new one must be performed. This is because it is important to rule out a cervical or endometrial cancer. If a PAP smear is performed and the results are negative, then the GP will not need to refer you to a specialist. However if the laboratory finds any abnormal cells, they will proceed with further testing.

Your GP may decide to refer you for an ultrasound of your uterus and ovaries. 

How certain am I that an ultrasound will accurately determine I do not have cancer? 

A negative ultrasound has a strong predictive value, meaning if the ultrasound shows thatthe thickness of your uterine lining is thin, then you can be 99% sure that you do not have endometrial cancer. 

So in summary for new onset post-menopausal bleeding your GP will request a PAP smear and/or transvaginal ultrasound. Once these results are known, then a decision will be made whether to refer you to a specialist. 

What if the vaginal blood loss returns despite the previous ‘negative’ results? Should I then get a referral? 

Absolutely! Early detection is very important, and if you develop a recurrence of vaginal blood loss, your GP should refer you immediately to a specialist for further work-up such as histology. 

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Would you like to discuss your (post-menopausal) vaginal bleeding with a doctor? Just book a consultation at HelloDoc Health! Our consults start with € 24.99 per consult.

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