UPDATES IN DIAGNOSIS AND MANAGEMENT OF POSTMENOPAUSAL BLEEDING AND ITS ASSOCIATED ANXIETY: A SYSTEMATIC REVIEW

Objectives: To review the diagnosis and management of postmenopausal bleeding (PMB). Methods: We conducted a thorough search of PubMed, SCOPUS, Web of Science, and Google Scholar to find pertinent literature. Rayyan QRCI was utilized during the entire process. Results: We included twelve studies with a total of 1859 participants. Hysteroscopy is the most acceptable tool to initially manage cases with PMB to stop the bleeding. Endometrial biopsies have been demonstrated to be beneficial in cases when malignancy is suspected. Spiral artery power and velocity addition Doppler flow mapping can help distinguish between benign disease and endometrial cancer in patients with thicker endometrium. TVS with endometrial thickness (ET) assessment is a non-invasive, easily accessible, and costeffective method of diagnosis, it should be the first line of study in the examination of women with PMB who have suspected endometrial disease. SIS is a well-tolerated, safe, and uncomplicated treatment that yields excellent diagnostic accuracy. Diagnosis of the cause of bleeding and its management will relieve the associated anxiety. Conclusion: In clinical practice, PMB is an important factor for healthcare professionals. There is an ongoing debate on the best investigative order for patients with PMB. The goal of future studies should be to obtain higher accuracy with less interference. Blind biopsies should be avoided as they have the potential to overlook endometrial disease, particularly when it is localized. To detect intrauterine pathology, hysteroscopy with biopsy under visualization is a more accurate operation and needs to be preferred over blind methods. A common gynecologic problem that is never to be disregarded is PMB.