Published: 2022-02-25

Study of histopathological findings and clinical presentation in post-menopausal bleeding

Mahalakshmi Aravazhi, V. Breetha, Rashmi Ajit, S. Sruthi


Background: Aim of the research was to study the clinical significance of post-menopausal bleeding in terms of its risk factors, malignancy incidence, and histopathological evaluation for the cause of the post-menopausal bleed.

Methods: This prospective observational study was conducted in the department of gynecological in Kanyakumari Government Medical College in 100 post-menopausal bleeding per vaginam. Evaluated by history, clinical examination, and investigations like transvaginal sonography, endometrial biopsy, and cervical biopsy for all subjects, the specimens collected will be sent to the pathology dept for examination and reporting. A total of 17% of patients were observed with an enlarged uterus and 42% scanty uterine curettings.

Results: The maximum number of patients, 29%, were reported in the age group of 50 to 55 years with an average age of 54.27 years. Para 2 parity (49%) and body mass index (BMI) value 21 to 30 (60%) were reported maximum in all subjects. Hypertension (17%) was reported as a major risk factor for endometrial carcinoma. Most of the patients were found with simple hyperplasia without atypia 34 (34%), followed by atrophic endometritis 32 (32%), and minimum patients have observed complex hyperplasia with atypia 4 (4%).

Conclusions: The symptom indicating endometrial pathology in post-menopausal women is uterine bleeding. The incidence of a malignant cause of post-menopausal bleeding increases as the time lapse between menopause and the onset of bleeding increases. Atrophic endometritis (atrophic vaginitis) was found to be a major cause of post-menopausal bleeding. Post-menopausal hyperplasia carries a more serious threat of cancer than does premenopausal hyperplasia.


Post-menopausal, Histopathological, Bleeding, Malignancy, Clinical significance

Full Text:



Hawwa ZM, Nahhas WA, Copenhaver EH. Post-menopausal bleeding. Lahey Clinic Foundation Bulletin. 1970;19(2):61-70.

Cheema SZ, Saeed R, Ikram M. Post-menopausal bleeding. Professional Med J. 2008;15(3):328-34.

Astrup K, Olivarius NDeF. Frequency of spontaneously occurring post-menopausal bleeding in the general population. Acta Obstetricia et Gynecologica Scandinavica. 2004;83(2):203-7.

Brdley LD, Franalcone T, Magen AB. Radiographic Imaging techniques for the diagnosis of abnormal uterine bleeding. Obstet Gynaecol. 2000;27(2):245-77.

Parazzini F, Vecchia CLA, Bocciolone L, Franceschi S. The epidemiology of endometrial cancer. Gynecologic Oncology. 1991;41(1):1-16.

Norris HJ, Tavassoli FA, Kurman RJ. Endometrial hyperplasia and carcinoma. Diagnostic considerations. Am J Surg Pathol. 1983;7(8):839-47.

Alberico S, Conoscenti G, Vegliò P, Bogatti P, Di Bonito L, Mandruzzato G. A clinical and epidemiological study of 245 post-menopausal metrorrhagia patients. Clin Exp Obstet Gynecol. 1989;16(4):113-21.

Gordon MD, Ireland K. Pathology of hyperplasia and carcinoma of the endometrium. Semin Oncol. 1994;21(1):64-70.

Hunter JE, Tritz DE, Howell MO, DePriest PD, Gallion HH, Andrews SJ, et al. The prognostic and therapeutic implications of cytologic atypia in patients with endometrial hyperplasia. Gynecologic Oncology. 1994;55(1):66-71.

Goff BA, Kato D, Schmidt RA, Ek M, Ferry JA, Muntz HG, et al. Uterine papillary serous carcinoma: patterns of metastatic spread. Gynecologic Oncology. 1994;54(3):264-8.

F. Wong, KL Luk, AYK Wong, LCH Tang S. Findings in women with postmenopausal bleeding investigated with hysteroscopy. J Obstet Gynaecol. 2001;21(4):392-5.

Bharani B, Phatak SR. Feasibility and yield of endometrial biopsy using suction curette device for evaluation of abnormal pre and post-menopausal bleeding. J Obstet Gynecol India. 2008;58(4):322-6.

Asim SS, Akhter AZ. Frequency of women with post-menopausal bleeding. ANN Abbasi Shaheed Hospital, Karachi Med Dent Coll. 2004;9(1):506-9.

Tyagi R, Isaacs R, Dhar T. Postmenopausal Bleeding: Histopathological Spectrum and Association with Age and Clear Span: Case Series of 328 Cases. J Evol Med Dent Sci. 2014;3(26):7210-21.

Escoffery CT, Blake GO, Sargeant LA. Histopathological findings in women with post-menopausal bleeding in Jamaica. West Indian Med J. 2002;51(4):232-5.

Pacheco JC, Kempers RD. Etiology of post-menopausal bleeding. Obstet Gynecol. 1968;32(1):40-6.

Gredmark T, Kvint S, Havel G, Mattsson LÅ. Histopathological findings in women with post-menopausal bleeding. Br J Obstet Gynaecol. 1995;102(2):133-6.