English

Abstract

BACKGROUND: Postmenopausal bleeding is frequent in gynaecology and accounts approximately 510% of postmenopausal women. About 10% of women with postmenopausal bleeding have a primary or secondary malignancy. Common malignancies among them are endometrial cancer, cervical cancer or an ovarian cancer. The incidence of malignancy in postmenopausal period remains sufficiently high so it requires immediate investigation for early diagnosis, vigilant follow up and prompt treatment. AIMS & OBJECTIVES: (1) To evaluate cause of Postmenopausal Bleeding (2) To detect early pre-cancerous lesions (atypia) & endometrial hyperplasia (3) To confirm benign nature of problem by ruling out carcinoma, so that medical treatment or conservative surgery can be offered and unnecessary radical surgery can be avoided. MATERIALS & METHODS: Study Design: Non-randomised longitudinal prospective observational study. Place of Study: Department Of Obstetrics & Gynaecology, M.K.C.G Medical College & Hospital, Berhampur, Odisha. Duration 0f Study: October 2010 –March 2012. Selection of Subjects: All patients having established menopause except those undergone hysterectomy/premature menopause (<40 year)/on Hormone Replacement Therapy/on anticoagulant /having bleeding disorder included. Clinical & histopathological details were collected & analysed using mean & standard deviation. RESULTS: Total 140 cases found during study period making the incidence of PMB to be 5.1%.Mean age of PMB was 57.12 ± 9.13 years, Mean parity was 4.2, Mean duration since menopause was 9.2 ± 5.77 years. Majority (52.86%) had malignant cause & 47.14% had benign cause. Overall most common cause found was cancer cervix(40%) followed by endometrial carcinoma (9.28%).Most common histopathology change in endometrium found was atrophic endometrium (40.74%). DISCUSSION: 1) The incidence of PMB decreases with increasing age but the frequency of malignancy increased with increased age & increased with increased interval between PMB & menopause. 2) Diabetes, obesity & hypertension are common medical illness in patients with PMB. These are risk factors for endometrial cancer. CONCLUSION: 1) Carcinoma of genital tract is one of the most important cause of PMB, so early detection of the causes can be life saving. 2) Endometrial sampling is a cost effective procedure to rule out endometrial carcinoma /detect in very early stage.