Publication:

The clinicopathological study of postmenopausal bleeding

Background Postmenopausal bleeding (PMB) represents one of the most common reasons for referral to gynaecological services, largely due to suspicion of an underlying endometrial malignancy.

Methods The data was collected from 100 patients with postmenopausal bleeding per vaginum attending the outpatient department or admitted for evaluation under obstetrics and gynaecology in this prospective study. Written and informed consent was taken from all the patients enrolled in the study. They were evaluated by history, clinical examination and investigations like transvaginal sonography, endometrial biopsy, fractional curettage, Papanicolau smear done for all subjects and the specimens collected was sent to the department of pathology for examination and reporting. Descriptive statistics was applied and analyzed by percentages and chi square test.

Results In patients with post-menopausal bleeding, atrophic endometrium was seen in 31%, proliferative endometrium in 13%, isthmic endometrium in 5%, polyp in 5%, simple hyperplasia without atypia in 35%, simple hyperplasia with atypia in 3%, complex hyperplasia without atypia in 1%, complex hyperplasia with atypia in 1% and endometrial carcinoma in 6% of the patients with PMB. Benign conditions were seen in 94% and malignancy was seen in 6% cases.

Conclusions The most common causes for postmenopausal bleeding were endometrial hyperplasia (40%), atrophic endometrium (31%), isthmic endometrium (5%), polyp (5%), proliferative endometrium (13%) and endometrial carcinoma (6%). A definitive diagnosis of PMB can be made by histological evaluation. Obesity, hypertension, diabetes mellitus and age since menopause are the risk factors for PMB.