This chapter reviews evidence on various investigative modalities and management planning for women presenting to the gynaecology clinic with post-menopausal bleeding. It discusses some of the issues to be considered when planning a cost-effective, clinic-based service for these women. Dilatation and curettage (D&C) was for many years the investigation of choice in women presenting with post-menopausal bleeding. The Pipelle de Cornier is a widely used system. The system is a narrow plastic catheter, which is passed through the cervical canal into the uterine cavity. Transvaginal ultrasound (TVS) is an accurate, non-invasive diagnostic modality that enables examination of the uterine cavity and endometrium in the outpatient setting. With the uterus visualised in a longitudinal plane, the thickness of the endometrial echo can be measured. Endometrial polyps are a common finding in post-menopausal women and when they occur in association with post-menopausal bleeding they should be removed for histopathological diagnosis.

This chapter provides an overview of the contribution of ultrasound examination to the evaluation of gynaecological conditions. Ultrasound imaging can be used to assess women with a history of acute or chronic pelvic pain. The imaging allows a quick non-invasive assessment of the pelvis and abdomen and it may be used as the first line investigation of patients with pelvic pain to confirm or exclude the provisional diagnosis based on clinical history. Ultrasound imaging determines the extent of ovarian and adnexal involvement in women with pelvic inflammatory disease. Ultrasound is helpful in assessing women with a history of post-menopausal bleeding and it can distinguish between women with post-menopausal bleeding who need to undergo invasive testing from those who do not require any intervention. Ultrasound is used to determine both the pregnancy location and viability. Transvaginal ultrasound has an important role in the study of female fertility.