The clinicopathological study of postmenopausal bleeding

Rita D., Sunil Kumar K.S., Rithesh S.K.


Background: Postmenopausal bleeding (PMB) represents one of the most common reasons for referral to gynaecological services, largely due to suspicion of an underlying endometrial malignancy.

Methods: The data was collected from 100 patients with postmenopausal bleeding per vaginum attending the outpatient department or admitted for evaluation under obstetrics and gynaecology in this prospective study. Written and informed consent was taken from all the patients enrolled in the study. They were evaluated by history, clinical examination and investigations like transvaginal sonography, endometrial biopsy, fractional curettage, Papanicolau smear done for all subjects and the specimens collected was sent to the department of pathology for examination and reporting. Descriptive statistics was applied and analyzed by percentages and chi square test.

Results: In patients with post-menopausal bleeding, atrophic endometrium was seen in 31%, proliferative endometrium in 13%, isthmic endometrium in 5%, polyp in 5%, simple hyperplasia without atypia in 35%, simple hyperplasia with atypia in 3%, complex hyperplasia without atypia in 1%, complex hyperplasia with atypia in 1% and endometrial carcinoma in 6% of the patients with PMB. Benign conditions were seen in 94% and malignancy was seen in 6% cases.

Conclusions: The most common causes for postmenopausal bleeding were endometrial hyperplasia (40%), atrophic endometrium (31%), isthmic endometrium (5%), polyp (5%), proliferative endometrium (13%) and endometrial carcinoma (6%). A definitive diagnosis of PMB can be made by histological evaluation. Obesity, hypertension, diabetes mellitus and age since menopause are the risk factors for PMB.


Endometrial hyperplasia, Endrometrium, Postmenopausal bleeding

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Rossouw JE, Anderson GL, Prentice RL. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA. 2002;288:321.

Bhatla N. Abnormal and excessive uterine bleeding. Jeffcoate. Principles of Gynaecology 5th edition. Jaypee Brothers Medical Publishers pvt ltd. 2001;578-9.

Adams Hillard PJ. Benign diseases of the female reproductive tract. Berek and Novak’s Gynaecology 14th edition. Wolters Kluwer Health India pvt ltd. 2007;490-1.

Lidor A, Ismajovich B, Confino E, David MP. Histopathological findings in 226 women with post-menopausal uterine bleeding. Acta Obstet Gynecol Scand. 1986;65:41-3.

Hawwa ZM, Nahhas WA, Copenhaver EH. Postmenopausal bleeding. Lahey Clinic Foundation Bulletin. 1970;19:61-70.

Astrup K, Olivarius NDF. Frequency of spontaneously occurring postmenopausal bleeding in the general population. Acta Obstet Gynecol Scand. 2004;83:203-7.

Kadakola B, Gurushankar G, Shivamurthy G, Rashmi MN. Ultrasonographic evaluation of abnormal uterine bleeding in postmenopausal women. Int J Reprod Contracept Obstet Gynecol. 2015;4:229-34.

Nirupama V, Suneetha Y, Prabha Devi K. Post-Menopausal Bleeding: An Analytic Study of 100 Cases. International Journal of Science and Research. 2015:4:2319.

Jillani K, Bahadur RK, Maqsood SA. M.S prevalence of malignant Disorder in 50 cases of postmenopausal bleeding. J. Pak Med Asso. 2010:60:540.

Kothapally K, Bhashyakarla U. Postmenopausal bleeding: clinicopathologic study in a teaching hospital of Andhra Pradesh: IntJ Reprod Contracept Obstet Gynecol. 2013;2(3):344-48.