Clinicopathological evaluation of postmenopausal bleeding

Manjusha Agrawal; Monika K. Kotpalliwar; Swadha Kotpalliwar

doi:10.18203/2320-1770.ijrcog20184970

Authors

Manjusha Agrawal Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, India
Monika K. Kotpalliwar Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, India
Swadha Kotpalliwar Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20184970

Keywords:

Ca endometrium, Endometrium thickness, Menopause

Abstract

Background: Seventy percent of cases of postmenopausal bleeding have an innocent or harmless cause of bleeding but 30% of them are associated with malignancy. Hence it requires a thorough evaluation clinically and pathologically. As a considerable number of patients complaining of postmenopausal bleeding are reporting, the current study was undertaken to find out the incidence of the postmenopausal bleeding and the causes responsible for it.

Methods: A hospital based cross sectional study was performed on women with the history of post-menopausal bleeding. Patients with premature menopause whether surgical or natural (age <40 years), patients having bleeding from urethra or rectum and patients on hormone replacement therapy and anticoagulation therapy were excluded from the study. After the detailed history and a thorough examination, all the patients were subjected to USG. In cases, wherever required colposcopy, biopsy, laparotomy or hysterectomy was performed and were correlated histopathologically.

Results: Incidence of 11/1000 patients was found. The mean age of menopause was 46.99 years and mean duration was 7.20 years. Clinically the most common cause was Ca endometrium (26%), whereas histopathologically atrophy (34.61%) was the commonest cause. 61% had benign cause whereas 39% had malignant cause for post-menopausal bleeding.

Conclusions: From the study, it is revealed that the incidence of postmenopausal bleeding decreases with increase in the age of patient as well as with the increasing duration of the menopause. Scanty endometrium is associated normal histopathology of endometrium and hence patients of postmenopausal bleeding with endometrial thickness > 5 mm should be thoroughly investigated, treated and followed up meticulously.

Metrics

Metrics Loading ...

References

Narendra Malhotra Jeffcoates principles of Gynaecology Jaypee Brothers Medical Publishers 7th ed:862.

Khadija, Asaf H, samina Hamid. Causes of postmenopausal bleeding. Pak J Obstet Gynaecol 10(3):22-6.

Tahir SM Professional Med J Sep. 2008;15(3):328-4.

Wong SF, Luk KL, Wing Ayk, Tang LCH. Finding in the women with post-menopausal bleeding investigated with hysteroscopy. J Obstet Gynaecol 2001;21(4):392-95.

Lidor A, Ismajovich B, Confino E, David MP. Histopathological findings in 226 women with post-menopausal uterine bleeding. Acta obstetricia et Gynecol Scandinav. 1986 ;65(1):41-3.

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

Agrawal L, Fusey S: Role of vaginal scan in measurement of endometrial thickness in women with postmenopausal bleeding. Thesis for (M.D. Obst. Gynaecol ), Nagpur university, Nagpur, 1997.

Dørum A, Kristensen GB, Langebrekke A, Sørnes T, Skaar O. Evaluation of endometrial thickness measured by endovaginal ultrasound in women with postmenopausal bleeding. Acta obstetricia et Gynecol Scandinav. 1993;72(2):116-9.

Ind T. Management of postmenopausal bleeding Prog Obstet Gynaecol. 1998:13;361.

Haller H, Matejčić N, Rukavina B, Krašević M, Rupčić S, Mozetič D. Transvaginal sonography and hysteroscopy in women with postmenopausal bleeding. Int J Gynecol Obstet. 1996;54(2):155-9.

Reddi Rani P, Devi JK, Papa D, Jayanthis. Transvaginal sonography and progesterone challenge test for identifying endometrial pathology in postmenopausal women J Obstet Gynecol India.2002;52(1):135-8.

Nasri MN, JH Shephard, Setchall ME, Lowe DG, Chard T. The role of vaginal scan in measurement of endometrial thicknes sin postmenopausal women Brit J Obstet Gynaecol. 1991:98(5);470-5.

Karlsson B, Granberg S, Wikland M, Ylöstalo P, Torvid K, Marsal K et al. Transvaginal ultrasonography of the endometrium in women ith postmenopausal bleeding A nordiac multicentric study Am J Obstet Gynaecol 1995;172(5):1488-94.

Brewer JI, Miller WH. Postmenopausal uterine bleeding. Am J Obstet Gynecol. 1954;67(5):988-1013.