Investigation and management of women presenting with postmenopausal vaginal bleeding

Burbos, Nikolaos (2021) Investigation and management of women presenting with postmenopausal vaginal bleeding. Doctoral thesis, University of East Anglia.

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Postmenopausal vaginal bleeding (PMB) is a common gynaecological symptom that requires investigation to exclude an underlying malignant cause. Endometrial cancer is the most common malignancy diagnosed in women investigated for PMB. The risk of a patient being diagnosed with endometrial cancer varies depending on the presence or absence of certain clinical and demographic characteristics. Although all women presenting with PMB are referred urgently for investigation, the majority of the patients will be diagnosed with a benign pathology.

The main aim of the work included in this thesis is to present the development of diagnostic models that predict the risk of endometrial cancer in patients presenting with PMB. In addition, I attempted to quantify the risk of endometrial cancer in particular subgroups of women undergoing investigation for PMB.

I developed the idea for this project during my clinical training in Obstetrics and Gynaecology. Following literature review, I identified the need for new predictive models in patients presenting with PMB. The work presented in this thesis is based on prospective data collection of consecutive patients referred to a hospital clinic for investigation of PMB. In collaboration with my colleagues, I developed and internally validated two diagnostic predictive models, one based on clinical characteristics only and a second model incorporating clinical characteristics and the results of endometrial thickness measurement using transvaginal ultrasonography. Implementation of the predictive models in clinical practice will allow stratification of patients into risk groups and, subsequently, better prioritisation of the diagnostic tests. However, several other stages in the model development process such external validation and impact analysis are required prior to implementation of the models in clinical practice.

In other manuscripts included in this thesis, I evaluated the causes of PMB and quantified the risk of endometrial cancer for young postmenopausal women, women using hormone therapy and those with inadequate assessment of the endometrium on ultrasonography. The results of these studies help to improve our understanding of different steps of the investigation pathways for women with PMB.

Item Type: Thesis (Doctoral)
Faculty \ School: Faculty of Medicine and Health Sciences > School of Health Sciences
Depositing User: Chris White
Date Deposited: 09 Dec 2021 11:40
Last Modified: 09 Dec 2021 11:40

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