# Postmenopausal Problems: Geriatric Gynecology in the ED About This Podcast Menopause, defined as the time following 12 consecutive months of amenorrhea, brings a range of systemic physiological effects due to the significant hormonal changes occurring during the perimenopausal period. So, what may bring a postmenopausal patient to the emergency department?  In this episode, Dr. Jennifer Wang joins host Dr. Christina Shenvi to discuss postmenopausal ED complaints and considerations. Dr. Wang is a Clinical Instructor and Faculty Development Fellow at the University of Maryland who specializes in women’s health. Tune in to this episode to learn about postmenopausal bleeding (PMB), pelvic organ prolapse (POP) and postmenopausal urogenital complaints. The two also discuss the role of the ED when it comes to hormone replacement therapy (HRT), and highlight key considerations for ED practitioners when managing this population of patients.  Play the Episode https://youtu.be/RIUdQR073Ys Subscribe on YouTube Subscribe on iTunes Key Points Around 20% of patients will experience PMB. There are a variety of causes of PMB, so evaluation requires a thorough history and physical exam. The most common cause is atrophic endometrium, but 10-20% of cases are caused by reproductive cancers. Factors such as vaginal friability can make pelvic exams more difficult, and can be accommodated for to improve the patient experience.  POP may present with symptoms such as a bulge at the vagina or pressure, but some patients will be asymptomatic. On exam, you can use an anatomical approach to determine what is prolapsing within the pelvis.  Kegels and follow-up are the primary ED treatment. Asymptomatic patients may not require treatment.  Common urogenitary complaints include dryness and infections, including sexually transmitted infections, which should be screened for. When managing urogenitary complaints, consider local/topical treatments to minimize polypharmacy. Topical estrogen may be initiated in the ED and can be beneficial for a variety of concerns such as urinary tract infections, atrophy, and decreased lubrication. Be aware of types of HRT regimens (estrogen alone, or dual estrogen and progesterone therapy) and the risks and side effects associated with HRT which ay effect ED presentations. Related Resources Below are some resources which you may find helpful. JGEM | December 12, 2021 Ten Clinical Tips in the Assessment of Genitourinary Emergencies in an Older Adult Older adults frequently present to the emergency department with genitourinary (GU) complaints. The following are clinical tips to assess these hard-to-address concerns, and further details are covered in this podcast and article. Read Article PODCAST | February 2, 2018 Urinary Infections and Catheters in Older Adults GEMcast episode with Mary Mulcare about how to diagnose and treat UTIs, the dangers of catheters, and how to protocolize catheter reduction. Listen Now Next, listen to Precision Relief: Nerve Blocks for Pain in Older Patients with Dr. Robert Sternberg. Play Episode