Postmenopausal Uterine Bleeding Research Articles

High prevalence of dysfunctional uterine bleeding in candidates for metabolic/bariatric surgery: increased endometrial cancer risk?

BackgroundEndometrial cancer (EC) is the strongest obesity-associated malignancy and the fastest-growing cancer in young women. Early identification of EC and other endometrial pathology (malignant and nonmalignant) in women with severe obesity may improve treatment options and uterine preservation. Screening for endometrial pathology using abnormal or postmenopausal uterine bleeding (APUB) as a surrogate in women pursuing metabolic/bariatric surgery may be clinically beneficial, but data supporting this effort are limited. ObjectiveTo develop and institute a screening program for APUB as a surrogate for endometrial pathology in bariatric surgery candidates. SettingTwo, academic metabolic/bariatric surgery programs in Louisiana, United States. MethodsThe Modified SAMANTA is a 10-item questionnaire that was implemented to identify patients with APUB, specifically combining tools designed to identify anovulatory/postmenopausal and heavy menstrual bleeding. Demographic (age, race), body mass index, and questionnaire data were analyzed with respect to positive screening using data from March 2021 through May 2023. ResultsOf 1371 eligible women presenting for surgical evaluation, 664 (48.4%) positive screens were identified and referred for gynecologic evaluation to rule out endometrial hyperplasia/cancer or other endometrial pathology. The likelihood of positive screening for APUB was associated with increasing BMI (P = .001) and Black/African American race (P = .003), as well as increasing SAMANTA score (P < .001). In contrast, risk of positive screening was negatively associated with increasing age (P < .001). ConclusionsWomen presenting for metabolic/bariatric surgery have a high prevalence of APUB and, given this dysfunctional bleeding and concurrent obesity, are at greater risk for underlying EC. Potential risk factors for APUB, given their associations with screening positive, include increased body mass index, younger age, and Black/African American race. Standardized screening with appropriate gynecologic referral should be a routine part of the overall evaluation for women with severe obesity.

Transvaginal natural orifice endoscopic surgery (vNOTES) for elderly patients.

To evaluate the feasibility and safety of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) in patients 70 years and over. The study consisted of eleven patients aged 70 and over who underwent vNOTES for a variety of gynaecological indications at a tertiary referral hospital. The medical and surgical data were noted: age, parity, history of comorbidity, number and type of previous surgeries, body mass index (BMI), operating time, the requirement of intraoperative conversion, the presence of intra- or postoperative complication, estimated blood loss, pre-and postoperative hemoglobin levels, visual analog scale (VAS) pain scores at 6th, 12th and 24th hours, length of hospital stay, and the final pathology results. vNOTES surgery was performed safely and successfully in eleven patients. There were no intra- and postoperative complications or instances of conversions to conventional laparoscopy or laparotomy. The mean age of patients was 75.91 ± 6.47 (range 70-93), and the mean BMI was 42.49 ± 8.77 kg/m2 (range 30.2-56). Seven cases of endometrioid adenocarcinoma, two cases of uterine leiomyoma, one case of complex atypical hyperplasia, and one case of postmenopausal uterine bleeding due to atrophic endometrium were diagnosed. All endometrial carcinomas were early stage; no adjuvant therapy was needed. vNOTES seems to be a safe and feasible approach for the treatment of gynecologic pathologies in elderly patients. This study suggests that vNOTES become a viable treatment option for existing minimally invasive procedures since it offers better surgical outcomes in various gynecologic surgeries.

Comparing endometrial biopsy results with hysteroscopic pathology in women presenting with abnormal and postmenopausal uterine bleeding

ObjectiveTo compare pathology results after office-based blind endometrial biopsy and pathology results from hysteroscopy in women presenting with abnormal uterine bleeding (AUB). MethodsA retrospective cohort study of biologic women presenting with AUB at a tertiary care referral care center. Patients were included if they underwent evaluation with blind endometrial biopsy performed in the office followed by hysteroscopy within one year. Hysteroscopic findings and pathology were correlated with index endometrial biopsy findings. Results689 patients met inclusion criteria. The mean age and BMI were 49 (±10) years and 31 (±8) kg/m2. The median duration of bleeding leading up to presentation was of 3.5 (1.5–9) months. Of the patients who had operative hysteroscopic pathology demonstrating endometrial polyp, 30.6 % (81) had a polyp detected on office endometrial biopsy. Of the patients who had hysteroscopic pathology demonstrating intracavitary fibroids, 0 % (0) were detected on endometrial biopsy. Of the patients who had hyperplasia without atypia on hysteroscopy, 28.6 % (4) were detected or suspected on endometrial biopsy. Of the patients who had hyperplasia with atypia on hysteroscopy, 5.9 % (1) were detected or suspected on endometrial biopsy. There were 12 cases of confirmed or suspected malignancy on hysteroscopy, of which 8.3 % (1) were detected on endometrial biopsy. ConclusionConcordance between focal findings on office hysteroscopy and endometrial biopsy is low. Endometrial biopsy when malignancy is suspected has been shown to be of benefit, but in the setting of suspected benign focal pathology, blind assessment of the endometrial cavity for definitive diagnosis should be abandoned. In women with symptomatic uterine bleeding, hysteroscopic visualization is associated with increased sensitivity in identifying intrauterine pathology.

P-584 Treatment of benign uterine bleeding in morbidly obese postmenopausal women with an aromatase inhibitor

Abstract Study question Can morbidly obese women with postmenopausal bleeding, a benign endometrial biopsy, and no response to an oral progestin be successfully treated using an aromatase inhibitor? Summary answer Postmenopausal uterine bleeding in morbidly obese women with benign endometrial histology and an elevated serum estrone level do respond to treated with an aromatase inhibitor. What is known already Morbidly obese postmenopausal women who have uterine bleeding and a benign endometrial biopsy are commonly not good surgical candidates, and need good medical treatment options especially when treatment with an oral progestin has failed. The etiology for uterine bleeding in these individuals can stem from elevated estrogen production from peripheral sources. Study design, size, duration This was a prospective, proof of concept study with no placebo control group. Ten morbidly obese postmenopausal women with elevated serum estrone levels and uterine bleeding for &amp;gt; eight weeks who had failed oral progestin therapy were treated with letrozole 2.5 mg/d and evaluated monthly for 3 months duration. At the first monthly follow-up visit, serum estrone levels were re-assessed. Vaginal bleeding was re-assessed at each monthly follow-up visit. Participants/materials, setting, methods This study was performed in an outpatient setting at a private health system. Inclusion criteria included postmenopausal uterine bleeding (not spotting), age &amp;gt; 50, postmenopausal status (based on an FSH level of &amp;gt; 40 mIU/mL and an estradiol &amp;lt; 25 pg/mL), an estrone level &amp;gt; 30 pg/mL, a BMI &amp;gt; 40 kg/m2, a benign endometrial biopsy, a normal pelvic ultrasound, and failure of progestin therapy. All women received letrozole 2.5 mg/d and were evaluated monthly. Main results and the role of chance Ten women were enrolled in the study. Their ages ranged from 51 to 68. Their mean BMI was 50.75 kg/m2. All of the women in the study had daily vaginal bleeding for &amp;gt; 8 weeks that was greater than spotting, and had additional co-morbidities that made them poor surgical candidates. Serum estrone levels pre-treatment ranged from 63 pg/mL to 550 pg/mL with a mean of 216 pg/mL. After 4 weeks of treatment with letrozole, 8 women had complete cessation of their vaginal bleeding which was sustained for the complete 3 months of follow-up. The two other women in the study had significantly reduced vaginal bleeding from treatment month one to 3 based on self-reporting. Serum estrone levels after 4 weeks of treatment with letrozole dropped by an average of 71% with a range of 50% to 93%. There were no serious adverse events, and no treatment tolerability complaints. Since there was no control group for comparison, the reductions in both vaginal bleeding and serum estrone levels could be from chance alone, including regression to the mean, and not treatment related. Limitations, reasons for caution This was a small, proof of concept study that was performed in a select population of patients. Although a very favorable outcome was obtained in our study population, a much larger study might show both a reduced success rate in regards to vaginal bleeding and some significant adverse events. Wider implications of the findings The data from this study suggests that morbidly obese postmenopausal women with uterine bleeding and benign endometrial histology who have failed oral progestin therapy, are poor surgical candidates, and in whom IUD placement may be very difficult, may have another good treatment option. Trial registration number N/A

Analysis of risk factors and construction and validation of a predictive model for determining the risk of endometrial cancer in postmenopausal patients with abnormal uterine bleeding

The data of 174 postmenopausal patients with abnormal uterine bleeding admitted were assessed to determine associated risk factors and develop and validate a prediction model to evaluate the risk of endometrial cancer in these patients. The patients were divided into a study group and a control group, among which 62 patients were diagnosed with endometrial cancer. A binary logistic regression analysis model using multifactorial regression analysis was established, and a column line graph of the prediction model was created using the R software. The model’s goodness-of-fit test was performed using the Hosmer-Lemeshow test, and SPSS (version 27, International Business Machines Corporation, Armonk, NY, USA) was used to plot the receiver operating characteristic (ROC) curve to evaluate the model’s predictive value. Binary logistic multifactorial regression analysis revealed that elevated body mass index (BMI), human epididymal protein 4 (HE4), cancer antigen 125 (CA125), combined fibroids and thickened endometrial cancer were risk factors for endometrial cancer in patients with abnormal postmenopausal uterine bleeding, based on which a probability model for predicting the risk of developing endometrial cancer in patients with abnormal postmenopausal uterine bleeding was constructed, and represented as P = 1/[1 + exp (4.227 − 4.594X1 − 2.029X5 − 1.165X6 − 1.817X7 − 2.080X8)]. In addition, the goodness-of-fit test, assessed using Hosmer and Lemeshow, yielded an χ2 value of 14.253 and a p-value of 0.075. Furthermore, the ROC curve analysis demonstrated an area under the curve (AUC) of 0.993 (95% confidence interval (CI), 0.892–0.974; p &lt; 0.05). In conclusion, elevated BMI, HE4 and CA125, along with the presence of combined fibroids and thickened endometrial lining, were identified as significant risk factors for endometrial cancer in postmenopausal patients with abnormal uterine bleeding. The risk prediction model developed in this study provides a scientifically sound approach to assess the risk of endometrial cancer in these patients.

Epidermal growth factor receptor-mutated lung adenocarcinoma diagnosed from endometrial polyp metastasis: A case report and literature review

Endometrial metastasis from the lung primary remains is rare. Moreover, the literature only contains case reports of endometrial metastasis from the primary lung cancer. An 83-year-old female patient presented with postmenopausal uterine bleeding and anemia. Endometrial thickening was detected using transvaginal ultrasound and endometrial curettage was performed. Histopathology revealed adenocarcinoma infiltration on an endometrial polyp surface. On histologic examination, high-grade serous carcinoma and clear cell carcinoma diagnoses were initially considered. The tumor cells were immunohistochemically negative for Wilms’ tumor 1 and wild-type for p53 expression; however, it was positive for Napsin A. Primary lung adenocarcinoma (LUAD) metastasis was also included in the differential diagnosis. Thyroid transcription factor 1 was positive, whereas paired box gene 8 (Pax8) was negative in tumor cells. Primary LUAD metastasis was diagnosed since a lung mass was radiologically confirmed. Furthermore, epidermal growth factor receptor-exon 19 mutation was detected by molecular analysis. In addition to the clinical and morphological features, this case report emphasizes the importance of multiple immunohistochemical panel applications for the correct diagnosis.

Comparing endometrial biopsy results with hysteroscopic pathology in women presenting with abnormal and postmenopausal uterine bleeding

The primary objective of this study was to compare endometrial biopsy pathology results with subsequent operative hysteroscopy pathology in women undergoing evaluation for abnormal and postmenopausal uterine bleeding. The secondary objectives were to describe the length of time between the two procedures and to describe intermediate treatments utilized before hysteroscopy. This study is a retrospective cohort study of women presenting for evaluation of abnormal and postmenopausal uterine bleeding within a single hospital system between January 2015 and December 2018. Patients were identified by their Current Procedural Terminology codes for endometrial biopsy and surgical hysteroscopy. Women were included if they underwent endometrial biopsy followed by operative hysteroscopy within 24 months for abnormal uterine or postmenopausal bleeding. Women were excluded if they underwent more than one endometrial biopsy or hysteroscopy up to five years preceding or any time following the procedures, or who underwent endometrial biopsy followed by hysteroscopy after more than 24 months. We identified 2223 records of which 689 met criteria for inclusion. The mean age of the cohort was 49 (±10). 30.1% (206) were postmenopausal. The median duration of abnormal or postmenopausal bleeding leading up to time of biopsy was of 3.5 (1.5-9) months. Of the patients who had hysteroscopic pathology demonstrating endometrial polyp, 30.6% (81) had an endometrial polyp detected on biopsy. Of the patients who had hysteroscopic pathology demonstrating fibroid/smooth muscle/myometrium with fibroid visualized on hysteroscopy, 0% (0) were detected on biopsy. Of the patients who had hyperplasia without atypia on hysteroscopy, 28.6% (4) were detected on biopsy, and of the patients who had hyperplasia with atypia on hysteroscopy, 5.9% (1) was detected on biopsy. There were 12 cases of confirmed or suspected malignancy on hysteroscopic pathology, of which 8.3% (1) was detected on biopsy. Of the patients who had insufficient specimen from endometrial biopsy, 21% (15) had insufficient specimen from hysteroscopy. The median number of days from endometrial biopsy to hysteroscopy was 48 (25-95) days. The most common non-surgical treatments used between time of biopsy and hysteroscopy were daily oral hormonal therapy at 11.3% (78), high dose oral hormonal therapy at 5.7% (39) and tranexamic acid at 1.5% (10). The overall adverse event rate for hysteroscopy was low at 1.3% (9). In this study of women with abnormal or postmenopausal uterine bleeding undergoing evaluation, the majority of endometrial polyps and fibroids found on hysteroscopic evaluation were not detected on endometrial biopsy. Hysteroscopy is a low-risk surgery that can be scheduled within a reasonable amount of time following endometrial biopsy to both evaluate and treat uterine bleeding.

Preferential HER2 Expression in Lymphovascular Invasion of a Uterine Carcinosarcoma, a Case Report

Abstract Introduction/Objective Uterine carcinosarcoma (UCS) is a rare, highly aggressive cancer accounting for &amp;lt;5% of reported uterine cancer cases. Commonly, myometrial invasion and lymphovascular invasion (LVI) are found at diagnosis, and recurrence rates of &amp;gt;40% are seen after therapy accounting for poor prognosis and high rate (16%) of death. Histologically, it is composed of both carcinoma and sarcoma components. HER2-targeted therapy without adjunctive chemotherapy for the treatment of UCS has generally not shown beneficial clinical responses, but a more recent phase II clinical trial revealed that the addition of Trastuzumab, a HER2-targeted monoclonal antibody, to carboplatin-paclitaxel chemotherapy showed an increase in progression free survival. Methods/Case Report Immunohistochemical (IHC) staining for HER2 was performed on histologic sections of UCS, areas of LVI, and lymph node metastasis (LNM). Confirmatory HER2 fluorescent in situ hybridization (FISH) studies were performed on the primary UCS and the LVI portion. A 67-year-old female presented with postmenopausal uterine bleeding. CT showed an enlarged uterus, widened endometrial canal, and enlarged lymph nodes. Initial endometrial biopsy showed UCS. Exploratory laparotomy with total abdominal hysterectomy, bilateral salpingo-ophorectomy, omentectomy, and lymph node dissection was performed with pathology confirming UCS with 86% myometrial invasion and LVI. Results (if a Case Study enter NA) NA Conclusion HER2 expression in this patient was solely seen in foci of LVI and within LNM. This finding suggests inclusion of histologic sections with LVI and LNM when evaluating for the presence of HER2 expression in uterine carcinosarcoma with reflex FISH testing when indicated may be helpful to provide additional treatment opportunities for patients. Further studies need to be performed to determine if this finding in generalizable to carcinosarcoma and endometrial serous carcinoma samples.

The risk of endometrial (pre)malignancy in women having postmenopausal uterine bleeding at Tu Du Hospital

Endometrial cancer and endometrial atypical hyperplasia, futher referred to as endometrial (pre)malignancy in approximately 8.3-17.6% of cases depending on different studies. The incidence of abnormal endometrium increases during the postmenopausal period, especially endometrial (pre)malignancy. There are limited data regarding endometrial (pre)malignant disorders in patients with postmenopausal uterine bleeding. The aim of this study is to investigate the risk of endometrial cancer and atypical hyperplasia in the women who had postmenopausal uterine bleeding (PUB) and assess the risk factors associated with such cases. A cross-sectional study was conducted on 164 women with PUB used vacuum aspirator with Karman canula to evaluate endometrial pathology, underwent treatment at deparment of Gynaegology, Tu Du hospital through a set of questionaires and case file reports completed from February to June of 2020. In Bayesian inference, the risk of endometrial (pre)malignancy was 17.5%, CI (credible interval) 95% of 14.1 to 21.1%. There was a significant association between the risk and the duration of bleeding (OR = 1.02, CI 95% 1.01 to 1.03, LR+ 1.96, LR-0.37), number of live births (OR = 0.79, CI 95% 0.66 to 0.95, LR+ 2.41, LR- 0.76), endometrial thickness (OR = 1.08, CI 95% 1.01 to 1.16, LR+ 1.16, LR- 0.77) and the presence of abnormal intracavitary mass in transvaginal ultrasound (OR = 9.12, CI 95% 4.09 to 20.33, LR+ 3.65, LR- 0.4). Using manual vacuum aspirator with Karman canula showed the risk of (pre)malignancy in women having PUB and this risk depends on the presence of the risk factors.

A rare ovarian hilus cell tumour accompanying bilateral serous cystadenomas: report of a case

BackgroundHilus cell tumours is considered an uncommon branch of androgen producing neoplasms that accounts for < 5% of all ovarian tumours. They are mostly benign and have characteristic gross and microscopic features. Here we present the first case of a hilus cell tumour in association with bilateral serous cystadenomas.Case presentationA 65-year-old lady with no symptoms of virilization, presented with postmenopausal dysfunctional uterine bleeding and radiological investigations revealing bilateral ovarian cysts that required a total abdominal hysterectomy with bilateral salpingo-oophorectomy. Gross and microscopic evaluation confirmed the diagnosis of hilus cell tumour associated with bilateral serous cystadenomas.ConclusionsThis was the first case of hilus cell tumour in association with bilateral serous cystadenomas of the ovaries. Although, majority of hilus cell tumours that have been reported in the literature were benign, further studies are required to determine the behavior of the disease.

Endometrial hyperplasia: current approaches to diagnosis and treatment. Literature review and own experience

Purpose of the study: to examine the morphological and immunohistochemical features of the endometrium in postmenopausal women with uterine bleeding, depending on body weight and metabolic syndrome.Materials and methods. The study included 114 women with postmenopausal uterine bleeding. Women were divided into 3 groups. Group I included 41 patients with overweight and obesity class I–II, group II – 43 women with metabolic syndrome, group III (control) consisted of 30 patients with normal body weight. Hysteroscopy with morphological analysis of biopsied material was performed for all patients of groups I and III and 41 patients of group II. Pathohistological and immunohistochemical analysis were used to diagnose endometrial pathology. The level of cell proliferation in the endometrium was assessed by immunohistochemical analysis using monoclonal antibodies for Ki-67 expression; antiapoptotic activity was determined by the Bcl-2 and COX-2 expression.Results. Endometrial pathology was diagnosed in 94.74% of women. Endometrial polyps in the structure of the identified pathologyprevailed in group I and control group III (82.93% and 83.33%, respectively), while endometrial polyps were detected in 25.59% of women in the group II. Endometrial hyperplasia was diagnosed in the vast majority (69.76%) in group II, hyperplasia without atypia was detected in 51.16% and endometrial hyperplasia with atypia in 18.60%.Conclusions. Endometrial hyperplasia value was higher in postmenopausal women with metabolic syndrome compared to patients with normal weight, overweight and obesity. There was an increase of Ki-67, Bcl-2 and COX-2 expression in the endometrial glands in women with metabolic syndrome in comparison to patients with normal weight and obesity, for which only increased Bcl-2 expression in the stroma was observed. This confirms the existing data on the predominance of the apoptosis inhibition over proliferation in the formation of endometrial diseases in the postmenopausal period and confirms the combination of hyperproliferative processes and apoptosis inhibition if there is metabolic syndrome.

Histopathological Findings in Iranian Patients with Postmenopausal Uterine Bleeding

Histopathological Findings in Iranian Patients with Postmenopausal Uterine Bleeding

Correlation between Endometrial Histopathology in Postmenopausal Uterine Bleeding and Transvaginal Colour Doppler

Background: Correlation between Endometrial Histopathology in Postmenopausal Uterine Bleeding and Transvaginal colour Doppler. Aim of the Work: To evaluation of transvaginal ultrasound and transvaginal color doppler of uterine arteries compared to endometrial histopathology in Postmenopausal uterine bleeding. Patients and methods: Prospective comparative observational cohort study. This study involving 90 patients complaining postmenopausal bleeding recruited from those attending in the Gynecology clinic in Obstetrics & Gynecology Department at “ Mansheat El-Bakery Hospital”. Results: The result found patients with endometrial carcinoma significantly in older age (P =0.009), with higher body mass index (BMI) (P 0.05). 5 mm endometrial thickness (ET) used the cutoff point to differentiate between malignant and benign malignancy. Malignant endometrial had a significantly (ET) compared to benign endometrium being ≥ 5mm (P <0.001). Conclusion: Regarding transvaginal ultrasound examination, 5 mm (ET) is used as the cutoff point for differentiating malignant from benign endometrium.

Evaluation of International Endometrial Tumor Analysis Sonographic Criteria in diagnosis of Endometrial Carcinoma

Postmenopausal vaginal bleeding is a sign that should not be Ultrasound imaging has become an effective diagnostic tool of gynecological practice throughout the years. Endometrial diagnosis typically involves invasive investigational approaches. Today, however, with the advent of high-resolution transvaginal ultrasound and Doppler ultrasonography (non-invasive diagnostic tool), is an alternative candidate to replace invasive approaches. The aim of this study is to evaluate the contribution of the terms and definitions described by the IETA group when designing a malignancy model for better diagnosis of malignancy in cases with postmenopausal uterine bleeding. In the present study 120 patients with postmenopausal bleeding were included in the study. The study was conducted from April 2017 to April 2019 at Tanta University hospitals, Obstetrics &amp; Gynecology and Diagnostic Radiology departments. Both patients were subjected to the following: full history taking, general examination, local examination, 2D transvaginal ultrasonography, Doppler study, hysteroscopy examination, endometrial biopsy. Symptomatic postmenopausal women with endometrial thickness &gt; 5 mm have been chosen because women with a lower endometrial thickness have a very low incidence of cancer and a prospective evaluation.

Histological Changes of Endometrium in Women with Postmenopausal Uterine Bleeding

Histological Changes of Endometrium in Women with Postmenopausal Uterine Bleeding

Postmenopausal Vaginal Bleeding Analysis and Sonographic Criteria in Diagnosis of Endometrial Carcinoma

Postmenopausal vaginal bleeding has a sign that should not be Ultrasound imaging has become an effective diagnostic tool of gynecological practice throughout the years. Endometrial diagnosis typically involves invasive investigational approaches. Today, however, with the advent of high-resolution transvaginal ultrasound and Doppler ultrasonography (non-invasive diagnostic tool), has an alternative candidate to replace invasive approaches. But in order to obtain an efficient ultrasound report there has must be unified the terms to define ultrasound diagnosis uterine pathology, and to develop the prediction and diagnosis of endometrial pathology. This problem has solved by The International Endometrial Tumor Analysis (IETA) group. There has no absolute diagnostic agreement on the presence of carcinoma, several research including patient characteristics and sonographic characteristics have been conducted to develop a model for endometrial cancer then estimate it has probability and clinical effectiveness, but these models have still not externally validated. The aim of this study has to evaluate the contribution of the terms and definitions described by the IETA group when designing a malignancy model for better diagnosis of malignancy in cases with postmenopausal uterine bleeding. In the present study 120 patients with postmenopausal bleeding have included in the study. The study has conducted from April 2017 to April 2019 at Pune University Pharmacy College, Pharmacology and Pharmaceutical Chemistry departments.Both patients have subjected to the following: full history taking, general examination, local examination, 2D transvaginal ultrasonography, Doppler study, hysteroscopy examination, endometrial biopsy. Symptomatic postmenopausal women with endometrial thickness > 5 mm have been chosen because women with a lower endometrial thickness have a very low incidence of cancer and a prospective evaluation.

Histopatología del endometrio en sangrado uterino en la Postmenopausia- Instituto Nacional Materno Perinatal

Objetivo. Determinar la prevalencia del tipo histológico del endometrio en pacientes con sangrado uterino en la postmenopausia. Materiales y métodos. Estudio observacional, retrospectivo, transversal. Se incluyeron 40 casos que tuvieron estudio histopatológico de pacientes que presentaron sangrado uterino cuyas edades comprendidas fueron de 50 a más años de edad. Se revisaron los hallazgos histopatológicos.

Relationship between endometrial thickness and neutrophil/lymphocyte ratio with endometrial malignancy in 386 postmenopausal uterine bleeding cases

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Temur M, Taşgöz F, Çakmak B, et al. Relationship between endometrial thickness and neutrophil/lymphocyte ratio with endometrial malignancy in 386 postmenopausal uterine bleeding cases. Journal of Obstetrics and Gynecological Investigations. 2018;1(1):29-34. doi:10.5114/jogi.2018.77761. APA Temur, M., Taşgöz, F., Çakmak, B., Çift, T., Üstünel, S., & Korkmazer, E. et al. (2018). Relationship between endometrial thickness and neutrophil/lymphocyte ratio with endometrial malignancy in 386 postmenopausal uterine bleeding cases. Journal of Obstetrics and Gynecological Investigations, 1(1), 29-34. https://doi.org/10.5114/jogi.2018.77761 Chicago Temur, Muzaffer, Fatma Nurgül Taşgöz, Burcu Dinçgez Çakmak, Tayfur Çift, Sibel Üstünel, Engin Korkmazer, and Mehmet Özgür Akkurt et al. 2018. "Relationship between endometrial thickness and neutrophil/lymphocyte ratio with endometrial malignancy in 386 postmenopausal uterine bleeding cases". Journal of Obstetrics and Gynecological Investigations 1 (1): 29-34. doi:10.5114/jogi.2018.77761. Harvard Temur, M., Taşgöz, F., Çakmak, B., Çift, T., Üstünel, S., Korkmazer, E., Akkurt, M., and Üstünyurt, E. (2018). Relationship between endometrial thickness and neutrophil/lymphocyte ratio with endometrial malignancy in 386 postmenopausal uterine bleeding cases. Journal of Obstetrics and Gynecological Investigations, 1(1), pp.29-34. https://doi.org/10.5114/jogi.2018.77761 MLA Temur, Muzaffer et al. "Relationship between endometrial thickness and neutrophil/lymphocyte ratio with endometrial malignancy in 386 postmenopausal uterine bleeding cases." Journal of Obstetrics and Gynecological Investigations, vol. 1, no. 1, 2018, pp. 29-34. doi:10.5114/jogi.2018.77761. Vancouver Temur M, Taşgöz F, Çakmak B, Çift T, Üstünel S, Korkmazer E et al. Relationship between endometrial thickness and neutrophil/lymphocyte ratio with endometrial malignancy in 386 postmenopausal uterine bleeding cases. Journal of Obstetrics and Gynecological Investigations. 2018;1(1):29-34. doi:10.5114/jogi.2018.77761.

The Diagnostic Value of Endometrial Biopsy in Postmenopausal Uterine Bleeding

The Diagnostic Value of Endometrial Biopsy in Postmenopausal Uterine Bleeding

Non-surgical interventions for treating heavy menstrual bleeding (menorrhagia) in women with bleeding disorders.

Heavy menstrual bleeding without an organic lesion is mainly due to an imbalance of the various hormones which have a regulatory effect on the menstrual cycle. Another cause of heavy menstrual bleeding with no pelvic pathology, is the presence of an acquired or inherited bleeding disorder. The haemostatic system has a central role in controlling the amount and the duration of menstrual bleeding, thus abnormally prolonged or profuse bleeding does occur in most women affected by bleeding disorders. Whereas irregular, pre-menarchal or post-menopausal uterine bleeding is unusual in inherited or acquired haemorrhagic disorders, severe acute bleeding and heavy menstrual bleeding at menarche and chronic heavy menstrual bleeding during the entire reproductive life are common. This is an update of a previously published Cochrane Review. To determine the efficacy and safety of non-surgical interventions versus each other, placebo or no treatment for reducing menstrual blood loss in women with bleeding disorders. We searched the Cochrane Cystic Fibrosis Haemoglobinopathies Trials Register (25 August 2016), Embase (May 2013), LILACS (February 2013) and the WHO International Clinical Trial registry (February 2013). Randomised controlled studies of non-surgical interventions for treating heavy menstrual bleeding (menorrhagia) in women of reproductive age suffering from a congenital or acquired bleeding disorder. Two authors independently assessed studies for inclusion, extracted data and assessed the risk of bias. Three cross-over studies, with 175 women were included in the review. All three studies had an unclear risk of bias with regards to trial design and overall, the quality of evidence generated was judged to be poor.Two of the studies (n = 59) compared desmopressin (1-deamino-8-D-arginine vasopressin) with placebo. Menstrual blood loss was the primary outcome for both of these studies. Neither study found clear evidence of a difference between groups. The first of these reported a mean difference in menstrual blood loss in the desmopressin versus placebo group of 21.20 mL (95% confidence interval -19.00 to 61.50)The second study reported that even though there was an improvement of pictorial bleeding assessment chart scores with desmopressin and placebo when compared to pretreatment assessment, there was no clear evidence of difference in these scores when the two were compared to each other (results presented graphically, P = 0.51). The data from these studies could not be combined.The third study (n = 116) compared desmopressin with tranexamic acid (n = 116). This study found a decrease in pictorial bleeding assessment chart scores after both treatments as compared to baseline. The decrease in these scores was greater for tranexamic acid than for desmopressin, with a mean difference of 41.6 mL (95% confidence interval 19.6 to 63) (P < 0.0002).In relation to adverse events, across two studies, there was no clear evidence of a difference when placebo was compared to desmopressin, risk ratio 1.17 (95% confidence interval 0.41 to 3.34) . The same was also true when desmopressin was compared to tranexamic acid, risk ratio 1.17 (95% confidence interval 0.41 to 3.34).Only the study that compared desmopressin to tranexamic acid assessed quality of life. However, we are unable to present any data from this study, since no differences in this outcome between the two intervention groups were reported. Evidence from randomised controlled studies on the effect of desmopressin when compared to placebo in reducing menstrual blood loss is very limited and inconclusive. Two studies, each with a very limited number of participants, have shown uncertain effects in menstrual blood loss and adverse effects. A non-randomised comparison in one of the studies points to the value of combining desmopressin and tranexamic acid, which needs to be tested in a formal randomised controlled study comparison.When tranexamic acid was compared to desmopressin, a single study showed a reduction in menstrual blood loss with tranexamic acid use compared to desmopressin.There is a need to evaluate non-surgical methods for treating of menorrhagia in women with bleeding disorders through randomised controlled studies. Such methods would be more acceptable than surgery for women wishing to retain their fertility. Given that women may need to use these treatments throughout their entire reproductive life, long-term side-effects should be evaluated.