Cause Of Postmenopausal Bleeding Research Articles

Postmenopausal Bleeding After Coronavirus Disease 2019 (COVID-19) Vaccination: Vaccine Adverse Event Reporting System.

We identified U.S. reports of postmenopausal bleeding in the VAERS (Vaccine Adverse Event Reporting System) between December 13, 2020, and December 13, 2021. Among 711,224 VAERS reports after coronavirus disease 2019 (COVID-19) vaccination, during our study period, we identified 554 presumptive postmenopausal bleeding reports; 434 were further classified as verified based on data abstracted from reports and medical records, when available. In the United States, by December 14, 2021, 58.8 million women aged 50 years or older had received at least one dose of a COVID-19 vaccine, corresponding to approximately seven verified VAERS postmenopausal bleeding reports per 1 million women aged 50 years or older who received a COVID-19 vaccine. Reports of postmenopausal bleeding after COVID-19 vaccination in VAERS were rare, and causes of postmenopausal bleeding based on medical record review were consistent with known causes of postmenopausal bleeding.

A prospective study of endometrial histopathology in post-menopausal women in Jharkhand.

Postmenopausal bleeding (PMB) refers to any uterine bleeding in a menopausal women. In the early menopausal years, endometrial hyperplasia, polyps and submucosal fibroids are common etiologies of post menopausal bleeding. The most common cause of postmenopausal bleeding is endometrial atrophy, comprises of 60-80%, while endometrial hyperplasia and endometrial cancer contribute to only 11% of Post menopausal bleeding. The aim of study is to analyses histomorphological pattern of endometrium in patients presenting with post-menopausal bleeding in Jharkhand. 103 postmenopausal women presenting to tertiary center of Jharkhand in 2020-22 with bleeding were subjected to endometrial curettage for histopathology. Analysis is based on morphological criteria to assess endometrium. Endometrial histology is of four categories: Proliferative, Secretory, premalignant and carcinoma. The highest incidence of postmenopausal bleeding was noticed in age group of < 60 years and incidence of malignancy was higher after 57 years of age. The majority of patients had parity between 1 and 3 (78.6%). Malignant & premalignant lesions comprises about 22.3% among that 77.7% were due to benign causes. Among the benign causes of postmenopausal bleeding, proliferative endometrium was the commonest finding. Types of hyperplasia encountered were simple hyperplasia without atypia (6.8%), Complex hyperplasia without atypia (3.9%),Complex hyperplasia with atypia (4.8%) and Simple hyperplasia with atypia (4.8%). 21.4% of cases of postmenopausal bleeding were associated with atrophic endometrium. Secretory endometrium seen in 17.5% of women. Endometrial carcinoma accounted for 12.6% of cases of postmenopausal bleeding. Out of these 69.2% were of endometroid type of endometrial carcinoma, 15.3% were of papillary serous carcinoma and 15.3% had clear cell carcinoma. The mean age of patients with endometrium carcinoma was 62.3 years. All cases of endometrial carcinoma were associated with 1 or more risk factor like diabetes/hypertension/Nulligravida. Proliferative Endometrium was a major cause of postmenopausal bleeding. Among the malignant causes, endometrial adenocarcinoma of endometroid type was most frequent with a lower mean age at presentation than other high grade cancers like papillary serous carcinoma & clear cell carcinoma.

Diagnostic Accuracy of Transabdominal and Transvaginal Ultrasound in Assessing Endometrial Pathologies in Women with Postmenopausal Bleeding: A Cross-sectional Study

Introduction: Postmenopausal Bleeding (PMB) is defined as any spontaneous bleeding occurring after 12 consecutive months of amenorrhoea due to ovarian follicular inactivity. Timely evaluation of PMB is crucial to exclude potential underlying cervical or endometrial malignancies, which are significant causes of mortality. Although endometrial biopsy is considered the gold standard for diagnosis, it is invasive and can be painful. Therefore, a less invasive screening tool is needed, which is where the role of Ultrasound (USG) comes into play to identify candidates for endometrial biopsies. Aim: To evaluate and compare the diagnostic accuracy of Transabdominal Sonography (TAS) and Transvaginal Ultrasound (TVS) in detecting endometrial pathology in postmenopausal women with bleeding and to compare these findings with endometrial biopsy results. Materials and Methods: This cross-sectional study, conducted from November 2020 to October 2022 in the Department of Radiodiagnosis at Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation Vijaywada, Andhra Pradesh, India, included 50 adult female patients of menopausal age with atleast 12 months of amenorrhoea. In these patients, endometrial thickness was measured using both TVS and TAS, after which they were referred to the Department of Gynaecology for endometrial biopsy. The patients were divided into two groups: those with endometrial pathology (40 patients) and those with other causes of PMB (10 patients). Quantitative, non normally distributed variables were analysed using the Wilcoxon’s Mann-Whitney U Test and the Kruskal-Wallis Test. Receiver Operating Characteristics (ROC) curve analysis with a &gt;5 mm cut-off for endometrial thickness was performed. Statistical significance was set at p&lt;0.05. Results: The mean age of the study participants was 59±7 years and the endometrial thickness measured using TAS was 4.46±3.05 mm, while the endometrial thickness measured using TVS was 5.28±3.83 mm. Significant differences were observed between the two groups (patients with and without endometrial pathology as a cause for PMB) regarding endometrial thickness, as measured by both TAS (W=446.000, p&lt;0.001) and TVS (W=442.000, p&lt;0.001). The endometrial pathologies identified in the study included endometrial atrophy (26 patients), endometrial hyperplasia (4 patients), endometrial carcinoma (7 patients), and endometrial polyps (3 patients). The strength of association, measured by Point-Biserial Correlation, was 0.69 for TAS and 0.70 for TVS, indicating a large effect size in both cases. Endometrial pathology was predicted with a sensitivity of 77% and specificity of 95% using TAS, and with a sensitivity of 85% and specificity of 89% using TVS. Conclusion: The present study emphasises that PMB is a prevalent concern in gynaecological practice, and ruling out endometrial cancer is critical due to its associated mortality. TVS remains a primary tool for identifying patients who require further evaluation through endometrial biopsy. Although TAS is initially performed for screening other pelvic pathologies and prior to conducting TVS, both modalities should be utilised.

Evaluation of Causes of Post-Menopausal Bleeding: A Hospital-Based Study

Midline cerebral congenital malformations, despite their relative rarity in the general population, with their high rate of Introduction: Postmenopausal bleeding is frequent in gynecology and occurs approximately in 5% to 10% of postmenopausal women. But most of the causes of post-menopausal bleeding are benign and treated conservatively. Women with postmenopausal bleeding have a primary or secondary malignancy of about 10%. So before starting treatment malignancy must be excluded. Common malignancies among them are endometrial or cervical carcinoma and rarely, ovarian cancer. The incidence of malignancy in the postmenopausal period remains sufficiently high, so it requires immediate investigations for early diagnosis, prompt treatment, and vigilant follow-up. The objective of the study is to evaluate the causes of postmenopausal bleeding in tertiary care hospitals in Dhaka city. Methods: This retrospective study was conducted at the Department of Obstetrics and Gynecology in Delta Medical College and Hospital, Dhaka, Bangladesh. The study duration spanned 12 months from July 2022 to June 2023. The study population consisted of 72 patients who presented with postmenopausal bleeding. The sampling for this study was conducted using a consecutive sampling method. Ethical approval was obtained from the ethical review committee of the study hospital. Descriptive statistics were used to summarize the demographic and clinical characteristics of the study participants. For the statistical analysis, the Statistical Package for the Social Sciences (SPSS). Results: Among 72 cases of postmenopausal bleeding, we found 9 cases of cancer (12.50%). Among them, 2 cases were cancer of the uterine cervix and 7 cases were cancer of the uterine corpus. Benign pathology was more frequent (63 cases: 87.50%), essentially presented atrophic endometritis 15 cases(20.83%), endometrial hyperplasia without atypia27.78% cases, endometrial polyp 16.67% cases, endocervical polyp 5.56% cases, cervical polyp 8.33%, leiomyoma found in 5.53% cases and preinvasive disease about 2.78% cases. Histopathological findings in 2 cases of carcinoma cervix were invasive squamous cell carcinoma and 7cases of endometrial cancer were endometrial adenocarcinoma. Cancer increased with advanced age while the incidence of bleeding decreased with age. Within 45 to 65 years of age is more frequent to develop post-menopausal bleeding. Conclusion: Even though causes of post-menopausal bleeding are mostly benign and treated conservatively but malignancy must be ruled out by endometrial and cervical biopsy.

Histopathological spectrum of lesions in evaluating the women with postmenopausal bleeding

Postmenopausal bleeding occurs in approximately 10% of postmenopausal women. Postmenopausal bleeding requires complete assessment to ensure the absence of malignancy. The aim of the study is to know the causes of postmenopausal bleeding based on Histopathological findings and the percentages of various benign, pre malignant and malignant lesions.This study included 53 cases attending the obstetrics &amp; gynaecology department of TMU&amp;RC, Moradabad western Uttar Pradesh with complaint of post menopausal bleeding over a time period of 2 years from July 2017-june 2019.Among benign cases, the most common cause was atrophic endometrium (39.6%). Among malignant cases, the most common cause was cervical malignancy (28.3%). Out of 53 cases, 26 cases account for premalignant and malignant causes of PMB, carcinoma cervix accounts for 53.7% and carcinoma in situ accounts for 3.8%.The postmenopausal bleeding is an important symptom and require careful and timely assessment to eliminate the possibility of malignancy as soon as possible.

Evaluation of Hysteroscopic Findings and Histopathologic Report of Endometrium in Postmenopausal Bleeding

Background: Women with postmenopausal bleeding have 10%-15% chance of having endometrial carcinoma and therefore the diagnostic work is aimed at excluding uterine malignancy. For accurate diagnosis of cause of postmenopausal bleeding, endometrial abnormalities can be assessed by hysteroscopy and hysteroscopy directed biopsy or fractional curettage. Objective: To compare the hysteroscopic findings with histopathologic report of endometrium in postmenopausal bleeding. Methods: Cross sectional study was conducted in the department of gynaecological oncology in Bangabandhu Sheikh Mujib Medical University over 1 year from June 2019 to May 2020. Thirty women with the complaints of postmenopausal bleeding were enrolled. Each women underwent hysteroscopic evaluation and endometrial tissue was obtained by hysteroscopy directed biopsy as well as fractional curettage in some cases, then sent for histopathology. Results were analyzed to find out sensitivity, specificity, accuracy, positive predictive value and negative predictive value of hysteroscopy, taking histopathological diagnosis as gold standard. Analysis was carried out by using SPSS version 26. Results: Hysteroscopic examination findings and histopathology of endometrium in 30 postmenopausal women, 11(36.6%) cases were found normal both on hysteroscopy and histopathology, among them 4(13.3%) cases were proliferative endometrium, 1(3.3%) was secretory endometrium and 5(16.6%) cases were found atrophic endometrium and 1(3.3%) tissue was insufficient. Hysteroscopic view of normal endometrium showed a sensitivity 100%, specificity 100%, positive predictive value 100%, negative predictive value 100% and accuracy 100%. For Endometrial polyp showed sensitivity, specificity, positive predictive value, negative predictive value and accuracy 100%respectively. For Hyperplasia, hysteroscopy showed sensitivity 100%, specificity 96.2%, positive predictive value 80%, negative predictive value 100% and accuracy 96.7%. Endometrial carcinoma was found in 3(10%) cases and showed sensitivity of 100%, specificity of 96.3%, positive predictive value 75.0%, negative predictive value 100% and accuracy 96.7%. For the atrophic endometrium, sensitivity (100%), specificity (96.0%), positive predictive value (83.3%), negative predictive value (100%) and accuracy (96.7%). 1(3.3%) had in situ endometrial carcinoma and 2(6.6%) had adenomyosis on histopathology. Conclusion: The study concludes that hysteroscopy and directed biopsy or fractional curettage is a highly accurate, sensitive, specific, positive predictive value and negative predictive value for diagnosis of cause of postmenopausal bleeding. Bangladesh Medical Res Counc Bull 2023; 49(1): 1-14

Various endometrial patterns and abnormalities in women with postmenopausal bleeding

Objective: To study the prevalence of various histopathological changes, patterns and lesions of endometrium in women with postmenopausal bleeding. Methodology: All the fixed specimens were processed and embedded in paraffin wax. Multiple serial sections of 4-5 microns thickness were obtained from the paraffin block and then stained with H &amp; E. The observations in our study were analyzed using SPSS software version 11.5. The average values are statistically calculated using Microsoft Excel computer software. Results: This was a prospective, non interventional and observational hospital based cross sectional one year study carried out in histopathology department on endometrial biopsies and hysterectomy specimens. Out of 50 cases, postmenopausal bleeding presented at a mean age of 53.38 years and was most common within 5 years of attaining menopause. Among the endometrial causes of postmenopausal bleeding, 16% were due to benign conditions, 10% were due to malignancy and in 74 % of cases were because of non organic causes comprising of proliferative, secretory and atrophic endometrium. Atrophic endometrium was most common among non organic causes ,endometrial polyp was most common among the benign causes followed by endometrial endometrioid carcinoma was a major finding among the malignant causes.

Histopathological Study of Endometrium in Postmenopausal Bleeding

Background &amp; objectives: Postmenopausal bleeding is frequent in gynecology and occurs approximately in 5% to 10 % of postmenopausal women. About 10% women with postmenopausal bleeding have a primary or secondary malignancy. Common malignancies among them are endometrial or cervical carcinoma and rarely, ovarian cancer. The incidence of malignancy in postmenopausal period remains sufficiently high, so it requires immediate investigations for early diagnosis, prompt treatment and vigilant follow up. The objective of the present study is to evaluate the causes of postmenopausal bleeding based on histopathology of endometrium and the percentage of various benign, premalignant and malignant lesions in patients with post-menopausal bleeding.&#x0D; Methods: A retrospective study was undertaken on 78 women presenting with postmenopausal bleeding in Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic disorders (BIRDEM) Hospital, Dhaka, from July 2018 to June 2019. Histopathological reports and patient’s profile were reviewed. Causes of bleeding were identified and related to patients’ age.&#x0D; Results: Among of 78 cases of postmenopausal bleeding, we found 8 cases of cancer (10.26%). Among them 2 cases were cancer of uterine cervix and 6 cases were cancer of uterine corpus. Benign pathology was more frequent (63 cases: 80.77%), essentially presented with endometrial hyperplasia without atypia 20.52% cases, endometrial polyp 16.67% cases, cervical polyp 14.11% cases, leiomyoma found in 9% cases and preinvasive disease about 9% cases. Histopathological findings in 2 cases of carcinoma cervix were invasive squamous cell carcinoma and 6 cases of endometrial cancer were endometrial adenocarcinoma. Cancer increased with increasing age while the incidence of bleeding decreased with age.&#x0D; Conclusion: Despite the fact that benign pathology is more frequent than malignancy as a cause of postmenopausal bleeding, we must always rule out a cancer by endometrial and cervical biopsy.&#x0D; Bangladesh J Obstet Gynaecol, 2020; Vol. 35(2): 112-116

Risk factors associated with postmenopausal bleeding and endometrial carcinoma.

Objective: The objectives of the study were to identify the common causes of post menopausal bleeding, benign and malignant causes of post menopausal bleeding and also the identification of risk factors for endometrial carcinoma in women with postmenopausal bleeding. Study Design: Cross sectional survey. Setting: Fauji Foundation Hospital Rawalpindi. Period: August 2018 to January 2019. Material &amp; Methods: A total of 224 women with post menopausal bleeding were included in this study. Data was collected through the self structured questionnaire in which we have included patient’s demographics, risk factors of Post menopausal bleeding and risk factors of endometrial carcinoma. Histopathological investigations of endometrial sampling were done for identification of benign and malignant causes of post menopausal bleeding. Results: Mean age of the women was 59.17 years and mean parity was found to be 2.24. Out of 224 patients 106(47.3%) women had their menopause in duration of 6 to 10 years while 75(33.9%) had menopause in time duration of first 5 years showing high frequency trend of post menopausal bleeding in first ten years duration after menopause. Out of 224 patients 30(13.4) were of normal weight, 94(42.0) were overweight while 100(44.6) were obese according to BMI criteria. Endometrial carcinoma was found in 40 women with post menopausal bleeding. Among them age at menarche was found to be 9 to 13 years in 27(67.5%) patients while more than 13 years in 13(32.5%) women. Age at menopause was found more than 55 years in 20(50%) patients while less than 55 years also in 20(50%) patients. Personal history of breast carcinoma was reported in 6(15%) similarly family history was also found in 6(15%) women. Family history of CA endometrium was observed in 3(7.5%). History of PCOs was also observed in 5(12.5) patients. Menstrual irreguraity in perimenopausal period was found in 18(45%) patients with endometrial CA. Nulliparity was reported in 21(52.5%) patients. 12(30%) were on estrogen use while 4(10%) were on Tamoxifen use. Conclusion: Diabetes Mellitus and Hypertension were observed as common risk factors for post menopausal bleeding. Endometrial Carcinoma, cervix carcinoma and Hyperplasia with atypia were common malignant causes while endometrial polyp and fibroid uterus were commonly found benign causes of post menopausal bleeding. Early menarche, menopausal duration of more than one year, obesity and diabetes mellitus were common risk factors for endometrial carcinoma.&#x0D;

Histopathological spectrum of lesions in women with postmenopausal bleeding

Introduction: Postmenopausal bleeding is regarded as an omnious and serious alarm of genital pathology. It is a symptom having various etiology and has a strong association with malignancy, which demands its thorough evaluation. Aims and Objectives: The present study was carried out to know the causes of postmenopausal bleeding based on histopathology and the percentage of various benign premalignant & malignant lesions in postmenopausal bleeding. The association with age was also studied. Methodology: This study included 139 specimens received in in Department of Pathology MMC & RI Mysore, with history of postmenopausal bleeding, from January 2013 to December 2014. Results: Mean age of the patients in the study was 57 years. Cervical biopsy was most common biopsy received (43.8%). Benign cases were 51.6%, malignant cases 36.07% and premalignant lesions were 9.27%. Among the benign lesions atrophic endometrium was most common (11.2%). Cervical cancer was most common (33%) among malignancy. Conclusion: Any patient presenting with history of postmenopausal bleeding should be investigated thoroughly to determine the cause of bleeding. Cervical lesions are still the most common cause postmenopausal bleeding so screening programme should be effectively implemented. Keywords: Postmenopausal bleeding, Histopathology.

Histopathological evaluation of endometrium in Postmenopausal bleeding

Aims & Objectives: 1. To evaluate various causes of postmenopausal bleeding in terms of functional and organic endometrial lesions on histopathological basis, 2. To confirm or to rule out the diagnosis of atypical or malignant endometrial lesions. 3. To help the gynecologists in diagnosis of endometrial cancer as early as possible. Materials and Methods: The study was carried out in the Department of Pathology, GMERS Medical College-Junagadh from January 2015 to September 2018 and includes 200 cases of postmenopausal women who presented with bleeding problems at our institute. Histopathological evaluation of endometrium was done in all these cases after clinical evaluation and final diagnosis was given in terms of organic or functional lesions. Results: Out of 200 cases, 36 cases (18%) showed organic lesions & 164 cases (82%) showed functional lesions. Among organic lesions, Simple & Typical Hyperplasia was the commonest one (12 cases), while among functional lesions, Atrophic Endometrium was the commonest one (88 cases). Atypical and Malignant lesions were commonly seen after 60 years of age. Conclusion: The role of histopathology remains always important in the evaluation of postmenopausal bleeding. Careful histopathological evaluation of endometrium is always necessary in order to confirm or to rule out premalignant or malignant lesions in order to save the patient’s life. Keywords: Postmenopausal Bleeding, Organic Lesions, Functional Lesions.

POSTMENOPAUSAL BLEEDING

Objective : To evaluate the etiology, incidence of malignancy and interval between menopause and onset of abnormal vaginal bleeding inpostmenopausal women. Design: Prospective study. Place And Duration of Study: The study was conducted at Bahawal Victoria Hospital,Bahawalpur for a period of 14 months (February 2002 to March 2003). Subjects: Thirty five cases of postmenopausal bleeding. Methods: Adetailed history was taken followed by a detailed general physical, abdominal, pelvic and per-rectal examination. Cervical pap smear was donein all the patients except those with obvious cervical growth. Besides routine laboratory work, abdominal ultrasonography was done in all thecases. All patients were invariably subjected to fractional curretage and cervical biopsy was taken where indicated. Results: Malignancy wasfound to be the most common cause (51.42%) of postmenopausal bleeding. Carcinoma of the cervix was commonest and found in 34.28%,carcinoma of endometrium in 11.42%, atrophic endometrium in 11.42%, polyps in 8.57%, chronic cervicitis in 8.57%, endometrial hyperplasiain 5.71%, carcinoma of ovary in 2.85%, liomyosarcoma in 2.85%, senile vaginitis, trauma, and forgotten IUCD each in 2.85% of cases. Etiologyremained undetermined in 5.71 % cases. Malignancy was directly related to years of clear span and was 88.88% in cases presenting 10 yearsor more after the menopause. Conclusion: Carcinoma of cervix was the commonest cause of postmenopausal bleeding in our study. Screeningprogramme for early detection of carcinoma of cervix at a pre-invasive stage is highly recommended.

Clinical and Sonographic Evaluation of Postmenopausal Bleeding (PMB) Followed by Diagnostic and/or Therapeutic Hysteroscopy and Guided Biopsy in Jordanian Hospitals.

Background and Objectives: The goal of this study was to evaluate the clinical sonographic evaluation of postmenopausal bleeding (PMB) followed by diagnostic and/or therapeutic hysteroscopy and guided biopsy in Jordanian hospitals. Materials and Methods: A retrospective multi-centric study was performed in hospitals in Al-Karak and Amman from 2014–2016. The study recruited 189 cases to evaluate the aetiology of postmenopausal bleeding. Atrophic endometrium was observed as a major cause of postmenopausal bleeding according to histopathology. The cases were also distributed according to parity in which nulliparous patients were observed. Results: Hysteroscopy was observed to be effective for the diagnosis of postmenopausal bleeding. Conclusion: There is a need to assess more approaches for the diagnosis of postmenopausal bleeding among women.

An unusual cause of postmenopausal bleeding: A case report

A 55year old postmenopausal woman presented to the gynaecology clinic with a 1week history of vaginal bleeding. She was investigated to rule out local and systemic causes including genital malignancy. The investigations were negative for genital malignancy and her symptoms settled with medical and surgical management. A short literature review of this unusual cause of postmenopausal bleeding is discussed here.

Clinicopathologic Characteristics and Causes of Postmenopausal Bleeding in Older Patients.

BackgroundThis study aimed to reveal the clinicopathologic features and causes of bleeding in older patients with postmenopausal bleeding (PMB) and to investigate the correlation between the ultrasonographic findings and etiology of PMB.MethodsWe retrospectively analyzed the causes and clinical characteristics of PMB in 498 patients who were diagnosed between January 2007 and December 2017. The population with PMB was divided into 2 groups according to age: Group A (n=204) included individuals more than 65 years of age and group B (n=294) included those less than 65 years of age. Clinical characteristics such as age, parity, underlying conditions, previous surgical history, and previous menopausal hormone therapy were compared between the groups. Cervical cytology testing and transvaginal ultrasonography were performed in all patients with PMB. Endometrial biopsy was performed in all cases of endometrial thickness ≥5 mm.ResultsWe examined 498 patients with PMB. In group A, atrophic endometrium (n=125, 61.27%) was the most common cause of PMB. Twenty-three patients had gynecological malignancy (cervical cancer: n=12, 5.88%; endometrial cancer: n=8, 3.42%; ovarian cancer: n=3, 1.46%), and 30 patients had benign gynecological disease (endometrial polyp: n=10, 4.90%; submucosal myoma: n=6, 2.94%; uterine prolapse: n=7, 3.42%; cervical dysplasia; n=5, 2.45%; cervical polyp: n=2, 0.98%). Forty patients had endometrial thickness ≥5 mm. Eight patients were diagnosed with endometrial cancer. All cases of endometrial cancer were diagnosed with endometrial thickness >10 mm.ConclusionAtrophic endometrium was the most common cause of PMB in both groups, and approximately 12% of cases were associated with gynecological malignancy in older patients.

Kadın hastalıkları ve doğum uzmanları vajinal kanama veya menometrorajili hastalara ne zaman endometrial biyopsi yapmalı?

OBJECTIVE: To compare endometrial biopsy results in patients with postmenopausal bleeding or menometrorrhagia METHOD: A retrospective analysis of probe curettage performed by a single doctor for diagnostic purposes in symptomatic patients at Yozgat Sorgun State Hospital between January 2015 and June 2016 RESULTS: The results of 128 patients were evaluated. The mean age of 14 menopausal patients and 114 premonopausal women were 56.6 + 9.3 and 44 + 6.7, respectively. The endometrial thickness was statistically significantly thicker in premenopausal than postmenopausal patients. The most common pathologies in symptomatic premenopausal women were endometrial polyp and endometrial atrophy. In postmenopausal patients, normal pathologic result, endometrial polyp, cervical polyp were observed equally. No endometrial carcinoma was detected in any case. CONCLUSION: The menstrual cycle normally lasts for 28 ± 7 days. Vaginal bleeding occurs approximately 2-6 days. The amount of bleeding is circa 20-60 ml. Any deviation from these values is called menstrual disorders. Menometrorrhage defines intermenstruel bleeding together with bleeding more than 80 ml and six days. Menometrorrhagia can be a symptom of many different spectrum of diseases. These diseases may also change with aging. In particular, endometrium cancer may occur with this symptom. Menorrhagia can also be seen in cases such as endometrial polyps, endometrial hyperplasia, endometrial atrophy, endometritis, submucous myomas, adenomyosis, ovarian cysts, haemostasis diseases. Postmenopausal vaginal bleeding occurs after the ceasing of menstruation for one year. Endometrial atrophy, endometrial polyp, endometrium cancer, hormone replacement therapy, endometrial hyperplasia, other genital cancers may be the causes of postmenopausal bleeding. It is interesting that no case of cancer has been detected in our study. However, pathologies such as endometrial polyps, endometrial hyperplasia, and cervical polyps were detected and treated at the same time. Endometrial biopsy in symptomatic pre- and postmenopausal patients is effective not only in cancer diagnosis but also in the diagnosis and treatment of benign conditions.

Clinical Study of Postmenopausal Bleeding

Background: Women with postmenopausal bleeding (PMB) should be thoroughly evaluated. A thorough examination may help in the diagnosis of vulval, vaginal, cervical or pelvic pathology.Objective: This study was carried out to find the probable causes in patients presenting with postmenopausal bleeding.Materials and method: This observational study included 50 women with postmenopausal bleeding and was conducted in the department of Obstetrics and Gynaecology of Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorder (BIRDEM) Hospital, Dhaka, Bangladesh, from January 2004 to December 2004. Transvaginal ultrasonogram (TVS), diagnostic curettage and cervical biopsy were done and histopathology report was collected.Results: The mean age of the patients was 57.74 years (range 48-75 years), and the median age of menopause was 50 years. Among the patients 18 (36%) had only diabetes and 25 (50%) patients had both diabetes and hypertension. Nineteen patients (38%) were overweight, 5 patients (10%) were obese and 2 (4%) were morbidly obese. Per speculum examination revealed suspected cervical carcinoma in 5 cases (10%) and cervical polyp in 1 case (2%). The most common clinical finding was atrophy of the uterus and vagina in 26 patients (52%). TVS revealed endometrial thickness of 5mm or more in 17 cases (37.7%) and &lt; 5mm in 26 cases (57.7%). Nine patients (18%) had carcinoma, 16 patients (32%) had benign pathology and 19 (38%) patients had endometrial atrophy on histology.Conclusion: A detailed history taking, thorough physical examination and relevant investigations can lead to a correct detection of cause of postmenopausal bleeding. Those who have normal adnexae and thin endometrium (endometrium &lt;5mm) may not need endometrial biopsy.Delta Med Col J. Jul 2017 5(2): 83-88

Common Causes of Postmenopausal Bleeding in Korean Women: 10-Year Outcomes from a Single Medical Center

The common causes of postmenopausal bleeding (PMB), according to the data from the western world, are atrophy, hormone replacement therapy (HRT), endometrial cancer, etc. We conducted a retrospective study to assess whether the causes of PMB in Korean postmenopausal women are similar to those already known. This retrospective study used 10-year medical records (March 2005 to December 2014) of 792 PMB women in the Yonsei University Health System. The data were divided into 2 categories by 5-year intervals to compare the differences between the 2 periods. The most common cause of PMB in Korean women was atrophy (51.1%). Polyps and HRT were the second, followed by anticoagulant medications, cervical cancer, and endometrial cancer. The proportion of patients with cervical cancer significantly decreased during the second half of the decade (8.7% vs. 5.2%; P = 0.048). Although no significant change was noted for HRT, its rank was higher during the latter 5-year period. Only the most common cause of PMB was the same as the conventional data. Interestingly, the proportion of patients with cervical cancer decreased during the latter half of the decade, reflecting the changes in the nation's cancer prevalence rate, while the use of HRT increased.

Tissue Insufficient for Diagnosis on Endometrial Biopsy

INTRODUCTION: Endometrial biopsy (EMB) has been the gold standard for diagnosing causes of postmenopausal bleeding (PMB) for the last 30 yrs. Occasionally the EMB does not contain sufficient tissue to make a definitive diagnosis. This often leads to additional procedures. In an effort to improve the care of these patients, we evaluated PMB patients whose initial EMB did not contain sufficient tissue for diagnosis. METHODS: We reviewed EMBs done at our institution during a single year for PMB that were read as tissue insufficient for diagnosis (TIS). We collected demographics data, ultrasound data, and final pathology findings from a subsequent procedure (D&C or Hysterectomy) within 12 months of initial endometrial biopsy. RESULTS: There were 118 TIS results for 890 EMBs done for PMB (13.2%). The age, BMI, endometrial stripe and uterine sound were 61.2±9.1 years old, 31.3±8.5 kg/m2, 7±4 mm and 7.6±1.7 cm (mean±SD), respectively. Of the 74 patients for whom we had additional tissue, 45 were atrophic (61%), 22 had endometrial polyps (30%), 6 proliferative (8%) and one endometrial cancer (1.3%). PMB patients with the two most common diagnoses (atrophy or polyps) did not differ in age, BMI, endometrial thickness, or uterine length. CONCLUSION: Insufficient tissue on EMB in PMB patients rarely results in serious endometrial pathology. The ability to differentiate between the two most common pathologies using ultrasound and demographics is difficult. Thus, the inclusion of a sonohysteroscopy may be helpful in determining the need for additional procedure.

Causes of postmenopausal bleeding in our population

Objective: To evaluate common causes of postmenopausal bleeding in our population. Study design: Observational Analytical study. Settings: Department of Obstetrics &amp; Gynaecology unit II Lady Willingdon Hospital Lahore from June 2000 to May 2002. Materials &amp; methods: Hysteroscopically directed endometrial biopsies were taken from 100 cases of postmenopausal bleeding and were sent for histopathology. The data was collected with the help of Performa which was filled for every patient. Results: In our part of world, Atrophic Endometrium is the commonest cause of Postmenopausal Bleeding (PMB). Next common being Endometrial Hyperplasias. Out of malignant causes, Carcinoma Cervix is the commonest. Conclusion: Postmenopausal bleeding (PMB) should be taken seriously; no matter how less the bleeding is and malignant causes should be ruled out.