Abstract
Post-menopausal bleeding (PMB) is usually caused by several endometrial conditions (hyperplasia and carcinoma) for which there are evidence-based treatments. However, there is little literature and no evidence-based treatments for a finding of proliferative endometrium without atypia on Pipelle endometrial biopsy in women presenting with PMB. Our aim is to explore management and treatment options for this subset of women. This is a retrospective, observational case series review of women presenting with PMB to a gynaecology rapid access clinic at a District General Hospital in Manchester, UK over a period of three weeks. Four women who were found to have a proliferative or secretory endometrium on endometrial Pipelle biopsy were chosen. Their history, examination findings, investigations, treatment and follow-up findings were then analysed. This case series has identified the management dilemma posed by patients with proliferative endometrium with no atypia on endometrial sampling. The four patients were followed-up with a repeat Pipelle endometrial biopsy six weeks after presentation to the specialist gynaecology unit. They were subsequently counselled or treated with oral progesterone therapy for six to eight weeks. The management options included the Mirena intrauterine system (IUS), oral progesterone therapy and discharging the patient back to primary care. There is no consensus on the importance of oral progesterone or the duration of follow up necessary to monitor for the development of endometrial hyperplasia or cancer in this subset of patients. Further research is needed to develop evidence-based, management guidelines for proliferative endometrium in women with PMB.
Highlights
Post-menopausal bleeding is an important and common presentation in gynaecology clinic
In this report we have analysed four cases of Post-menopausal bleeding (PMB) whose investigations found proliferative endometrium on histology. This case series is of interest because there is paucity of literature evidence on proliferative endometrium in postmenopausal women presenting with a symptom of PMB, and as a result no evidence-based treatment
This report will identify areas of uncertainty in our understanding and management of these patients. This is a retrospective, observational case series looking at women presenting with PMB to a gynaecology rapid access clinic (RAC) at a District General Hospital in Manchester over a period of 3 weeks in November 2014
Summary
Post-menopausal bleeding is an important and common presentation in gynaecology clinic. Urgent investigations are necessary to rule out endometrial cancer - the most common gynaecological malignancy in the United Kingdom [1]. Benign causes such as atrophic vaginitis, polyps and fibroids have the potential to cause significant stress to the patient. A histological diagnosis of proliferative endometrium without atypical cells leaves clinicians without evidence-based treatment and uncertainty as to its potential for malignant transformation. In this report we have analysed four cases of PMB whose investigations found proliferative endometrium on histology This case series is of interest because there is paucity of literature evidence on proliferative endometrium in postmenopausal women presenting with a symptom of PMB, and as a result no evidence-based treatment. This report will identify areas of uncertainty in our understanding and management of these patients
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