Postmenopausal bleeding
In postmenopausal vaginal bleeding, the primary goal of any diagnostic evaluations is to exclude endometrial hyperplasia and malignancy. Transvaginal ultrasonography and endometrial sampling are common methods for an initial evaluation. Guidelines from the American College of Obstetricians and Gynecologists (ACOG) recommend transvaginal ultrasonography as an appropriate first-line procedure to identify which patients are at higher risk of endometrial cancer. Endometrial sampling is indicated if having the following findings and/or symptoms:
Endometrial thickness greater than 4 mm
Diffuse or focal increased echogenicity (heterogeneity)
Failure to visualize the endometrium
Persistent or recurrent bleeding regardless of endometrial thicknessEndometrial sampling can be obtained either by an endometrial biopsy using an endometrium sampling device such as a pipelle or by dilation and curettage (D&C) with or without a hysteroscopy. FIGO classification
In 2011, the International Federation of Gynaecology and Obstetrics (FIGO) recognized two systems designed to aid research, education, and clinical care of women with abnormal uterine bleeding (AUB) in the reproductive years. Complications
Severe acute bleeding, such as caused by ectopic pregnancy and post-partum hemorrhage, leads to hypovolemia (the depletion of blood from the circulation), progressing to shock. This is a medical emergency and requires hospital attendance and intravenous fluids, usually followed by blood transfusion. Once the circulating volume has been restored, investigations are performed to identify the source of bleeding and address it.
Breastfeeding professionals that include nurses, midwives and lactation consultants are able to assist in the treatment of cracked nipples.Advice from others is abundant but there have been some treatments that have been identified as not being effective in healing or preventing cracked nipples. These ineffective treatments are keeping the breastfeeding short and using a nipple guard. Keeping the feedings short so that the nipples can rest is not effective in relieving the pain of cracked nipples and it could have a negative effect on the milk supply. Nipple shields do not improve latching on. Epidemiology
In a survey in New York City, 35% of nursing mothers stopped breastfeeding after one week due to the pain of cracked nipples. Thirty percent stopped breastfeeding between weeks one and three. Another survey of breastfeeding mothers in Brazil reported that there was 25% higher risk of interruption of exclusive breastfeeding when the women had cracked nipples. Mothers with higher education levels were more likely to continue breastfeeding despite the pain of cracked nipples. Society and culture
The importance of preventing cracked nipples while breastfeeding has been reported. In an informal survey of breastfeeding in the UK, some mothers reported that they stopped breastfeeding because the cracked nipples made it too painful. See also
List of cutaneous conditions

References
Bibliography
Henry, Norma (2016). RN maternal newborn nursing : review module. Stilwell, KS: Assessment Technologies Institute. ISBN 9781565335691. Dennis, Cindy-Lee; Jackson, Kim; Watson, Jo (2014-12-15). "The Cochrane Library". Cochrane Database of Systematic Reviews (12): CD007366. doi:10.1002/14651858.cd007366.pub2. PMID 25506813. == External links ==