Cause Of Postmenopausal Bleeding Research Articles

Primary malignant follicular lymphoma of the cervix: a rare cause of postmenopausal bleeding

Primary malignant follicular lymphoma of the cervix: a rare cause of postmenopausal bleeding

Primary malignant follicular lymphoma of the cervix: a rare cause of postmenopausal bleeding

Primary malignant follicular lymphoma of the cervix: a rare cause of postmenopausal bleeding

Histopathological findings of Post-Menopausal bleeding in Ethiopian women

Background: Postmenopausal bleeding is an alarming sign that may be associated with uterine malignancy. In recent years about 60% of women with post menopausal bleeding are said to have no organic cause in developed countries. There is no data concerning about this issue in Ethiopia. Objective: To determine histopathologic etiology of postmenopausal bleeding. Methods: Retrospective analysis of four years biopsy material from women with postmenopausal bleeding. Results: Four hundred seventy five patients with postmenopausal bleeding were included in the study. Malignant lesions of the genital tract were found in 289 (60.8%) cases. Cervical carcinoma was seen in 245 cases, which accounted for 84.8% of all malignant lesions. Cervical carcinoma was responsible for 51.6% cases of all postmenopausal bleeding patients. Endometrial carcinoma was seen only in 31(10.7%) cases among the malignant cases. In this study underlying cervical malignancy was found in approximately one of every two patients with postmenopausal bleeding. The result of this study doesn't show the dramatic decrease in the prevalence of malignancy as a cause of postmenopausal bleeding seen in Europe and USA. Conclusion: The famous dictum that "Post Menopausal bleeding must be considered as indicative of malignant disease until proven otherwise" still holds true in our circumstance. Priority should be given to introduce a screening method such as cervicography, gynoscopy and pap smear of the cervix to effectively manage gynaecological malignancies in elder women. (Ethiopian Journal of Health Development, 2001, 15(1): 39-44)

Hysteroscopy in the assessment of postmenopausal bleeding.

Although postmenopausal bleeding (PMPB) is a frequent problem in clinical practice and as such has major clinical relevance, the management strategies are often quite different. This review, after an introduction describing the various causes of PMPB, analyses in which order diagnostic procedures are indicated. There is much concern in decreasing the rate of invasive procedures; this is possible with the aid of transvaginal ultrasound (TVS) which is very reliable in excluding endometrial cancer at a thickness of < or = 4 mm. The vast majority of benign and malignant endometrial changes have an endometrial thickness of > 4 mm. Since the specificity of TVS for a pathological finding at a thickness of > 4 mm is low, other investigations are needed. Saline infusion sonohysterography (SIS), an easy complementary tool to TVS, and office hysteroscopy seem to give the same results, the first one being better accepted by the patients, the latter permitting biopsies and resections to be performed at the same time. Anyway, in all these cases a histological diagnosis is mandatory (endometrial biopsy/D&C/hysteroscopic resection). In cases of persisting or recurrent PMPB, independent of the TVS result, a hysteroscopy (with biopsy and/or resection) is mandatory.

Peritoneal seeding following hysteroscopic diagnosis of cervical adenocarcinoma

ObjectivesThe purpose of this case report is to highlight the need for caution when investigating postmenopausal bleeding.DesignA retrospective analysis of the management of a case of postmenopausal bleeding.SettingNorthampton District General Hospital, UK.SubjectThe patient was a 77‐year‐old woman with two episodes of unexpected bleeding whilst on continuous combined hormone‐replacement therapy.InterventionsAfter diagnostic hysteroscopy and curettage, a total abdominal hysterectomy and bilateral salpingo‐oöphorectomywas performed.ResultsHistological diagnosis revealed a stage 1A2 adenocarcinoma of the cervix and peritoneal washings taken at the time of hysterectomy were found to contain adenocarcinoma cells.ConclusionsThese include advocating the use of hysteroscopy and directed curettage for the investigation of abnormal uterine bleeding, but with some caution as hysteroscopy may be associated with peritoneal seeding of carcinomatous cells. Cervical, ovarian and fallopian tube carcinomas should be also considered as possible causes of postmenopausal bleeding.

Comparative Study of Transvaginal Hysterosonography and Biopsy for the Evaluation of Post-Menopausal Bleeding

The aim of this prospective study was to evaluate transvaginal hysterosonography (TVHS) in post-menopausal bleeding (PMB) as an alternative to endometrial biopsy. The study was conducted at the Zarka Military Hospital, Amman, Jordan, over a one-year period from 1996 to 1997. The study comprised 98 women presenting with post-menopausal bleeding who had been listed for diagnostic dilatation and curettage. Transvaginal sonography (TVS) and transvaginal hysterosonography were performed one week before operation. The mean age of the women was 57 years, and all of them had had their menopause for at least six months. Sixty-one women (62%) demonstrated endometrial thickness of more than 5 mm by transvaginal sonography. All the women had transvaginal hysterosonography, except seven on whom hysterosonography could not be performed for technical reasons and who had to be excluded from the study, leaving a total of 54 women. TVS confirmed the presence of endoluminal mass in 30 of 54 women (60%). Twenty-two of the 30 endoluminal mass cases were pedunculated while eight were sessile. Sixteen of the pedunculated cases were endometrial polyps while the remaining six were fibroid polyps. Five of the sessile cases were fibroid, two were endometrial hyperplasia, and the last one endometrial carcinoma. The other 44 out of the 98 patients also underwent transvaginal hysterosonography. No pathology could be detected in these patients, but they were noted to have atrophic endometrium after dilatation and curettage. The combination of transvaginal sonography and transvaginal hysterosonography is both sensitive and specific with regard to detecting and excluding endoluminal masses as the cause of post-menopausal bleeding. Diagnostic dilatation and curettage fails to detect a large percentage of some lesions, so TVS in combination with TVHS should be considered as the initial examination in the evaluation of all women with post-menopausal bleeding.

Transvaginal sonography and sonohysterography as screening tools for postmenopausal bleeding

The number of postmenopausal women in the United States is rapidly increasing, and the benefits of hormone replacement therapy (HRT) for the prevention of menopausal syndromes such as osteoporosis, coronary heart disease, and urogenital atrophy are documented. Accordingly, the number of patients using HRT constitutes an increasing percentage of obstetrician/gynecologist and other primary care physician practices. The risk of estrogen-stimulated endometrial hyperplasia and carcinoma in postmenopausal women with uteri in situ using HRT is effectively counteracted by progesterone, thereby making combined estrogen-progesterone HRT regimens safer than estrogen-only regimens. Bleeding, however, continues to be a common complaint among postmenopausal HRT users and nonusers. Despite recent research on the use of transvaginal sonography (TVS), with and without sonohysterography, as a screening tool for the diagnosis of the causes of postmenopausal bleeding, practitioners continue to rely on aspiration endometrial biopsy, hysteroscopy, and dilatation and curettage as the primary methods of evaluating such postmenopausal bleeding. This article evaluates the advantages of TVS, with and without saline infusion sonohysterography (SIS), as a screening tool for postmenopausal bleeding in HRT users and nonusers. Also, the potential of TVS, with and without SIS, to decrease the number of invasive procedures performed is explored.

An unusual cause of postmenopausal bleeding and incontinence of urine: primary lymphoma of the vagina

An unusual cause of postmenopausal bleeding and incontinence of urine: primary lymphoma of the vagina

Management of postmenopausal bleeding.

Postmenopausal genital bleeding is a symptom that requires thorough evaluation. In most cases the cause is benign. Nongenital and nonuterine causes will be found occasionally and should be managed accordingly. The principal thrust of management involves thorough history, examination, and interpretation of endometrial histology. The latter is especially necessary to exclude the most significant, but not most common, cause of postmenopausal bleeding, i.e., adenocarcinoma of the endometrium. Estrogen therapy contributes to postmenopausal bleeding and is usually contraindicated in such cases. Endometrial hyperplasia is considered a precursor lesion to endometrial carcinoma, but the incidence of progression is not great. Thus a scheme of conservative management that relies on repeat histologic examination of the endometrium to determine the biologic potential of endometrial hyperplasia is recommended. Although hospital D&C of the uterus is the traditional accepted method of evaluating the endometrium, there are persuasive reasons to consider suction endometrial biopsy as an appropriate alternative in most patients presenting with postmenopausal bleeding.

Postmenopausal Endometrial Tuberculosis

Summary: Three cases of postmenopausal tuberculosis endometritis are presented. The pathogenesis and treatment of the condition are discussed. Tuberculosis is a continuing problem, especially in older patients, and cannot be discounted as a cause of postmenopausal bleeding.

Aetiology of postmenopausal bleeding.

A series consisting of 1,085 women with postmenopausal genital bleeding was investigated. The women were at least 45 years old and the time lapse from the last menstruation was at least one year. The bleeding was due to a malignant process in 28%. The majority of these patients had endometrial or cervical carcinoma. The ratio of these two conditions was 1:1. The median age of the patients showing malignant growth was clearly higher than the median age of those in whom the cause of bleeding was benign. The rate of malignant tumours as a cause of postmenopausal bleeding showed a definite rise with increasing age.Atrophic endometrium was the cause of bleeding in 20.5% of the patients. A hormonal reaction in the endometrium was involved in 15.5%, an endometrial or cervical polyp in 17.2%, cervicitis with erosion in 12.1%, and senile vaginitis in 1.3%. The incidence of other benign conditions was low. The aetiology of postmenopausal genital bleeding is discussed.

Placental polyps—An unusual cause of postmenopausal bleeding

1.1. A case of placental polyps occurring five years after the menopause is reported.2.2. This condition represents an unusual cause of postmenopausal bleeding.3.3. A symptomatic placental polyp, occurring one or more years after the last pregnancy or abortion remains a clinical rarity.4.4. Expulsion of a placental polyp is not always associated with profuse vaginal bleeding.

Causes of postmenopausal bleeding

A clinical and pathologic study of bleeding after the menopause shows that in more than half the patients the cause of the bleeding is malignancy of the generative tract. This being a proved fact, the logical deduction is that a complete investigation of each case is imperative. In many cases this includes an examination of biopsied tissue by a competent gynecologic pathologist. There are, it is true, many benign causes of postmenopausal bleeding, most of which are easily cured, but pathologic studies indicate that the only safe assumption is that malignancy is responsible for the bleeding until unequivocally proved otherwise.

Granulosa-cell carcinoma of ovary as a cause of postmenopausal bleeding: With a discussion of the pathologic physiology of these tumors

A cause of postmenopausal hemorrhage not generally recognized by surgeons and pathologists is granulosa-cell carcinoma of the ovary. While rather rare, this tumor is of great biological interest, particularly because the tumor cells produce folliculin, and thereby, in the postmenopausal patient, bring about a species of rejuvenation in the uterus. Menstruation, or at any rate a periodic bleeding, is re-established, and the uterus often is as large as, or larger than, its pre-menopausal size. Hyperplasia of the endometrium, a condition commonly observed only during the reproductive years, is noted in these patients. When well-marked hyperplasia of the endometrium is revealed by diagnostic curettage, in cases of bleeding in elderly women, there should be strong suspicion of granulosa-cell ovarian tumor, even though none can be felt, and laparotomy would seem justified. If a tumor can be palpated, the suspicion becomes almost a certainty. Three additional cases of this type are reported, including one in which the tumor was of very small size, so that it caused no ovarian enlargement. This tumor proved to be of especial interest, not only because of its unusual histological structure, but because of the pathologic physiological effects which it produced upon the endometrium. The possibility of lutein-like transformation of the granulosal cells of the tumor is discussed as a possible explanation of the secretory changes seen in some of the endometrial glands. The significance of granulosa-cell tumors is discussed also from the standpoint of other physiological problems, such as the cause of menstrual bleeding, and the possibility of menstruation without ovulation.

Postmenopausal bleeding: A survey of 98 consecutive cases

1.1. Inasmuch as 68.4 per cent of the patients in our series with postmenopausal bleeding had conditions of a malignant nature, the axiom, “All cases of postmenopausal bleeding should be considered as malignancies until proved otherwise,” is very significant.2.2. The possible causes of postmenopausal bleeding are: carcinoma of the cervix, carcinoma of the corpus uteri, carcinoma of the vagina, carcinoma of the vulva, carcinoma of the ovary, zona granulosa tumor of the ovary, senile vaginitis, urethral caruncle, fibroids of the uterus, cervical erosions, prolapse of the uterus, cervical polyps, fibrosis uteri, nonspecific ulceration of the vagina, senile endometritis, sarcoma of the ovary, large cysts of the ovary, pyometra, twisting of the pedicle of an ovarian cyst, foreign bodies in the vagina or uterus, and carcinoma of the fallopian tube.3.3. Once the menopause has been definitely established (no menses for a period of six months to one year) all bleeding from the genitals should be considered as abnormal.4.4. There is no apparent relationship between the type or amount of bleeding and the seriousness of the existing condition.5.5. Parity, length of time in the menopause, and duration of active menstrual life are of no particular value as diagnostic aids.