Hysteroscopic evaluation of postmenopausal bleeding patients and its correlation with histopathological examination


  • Sudhir Mansingh Department of Obstetrics and Gynecology, Command Hospital Lucknow, Uttar Pradesh, India
  • Atmajit Singh Dhillon Department of Obstetrics and Gynecology, Maharishi Markendeshwar Institute of Medical Sciences and Research, Maulana, Haryana, India
  • Sandeep Sood Department of Obstetrics and Gynecology, Command Hospital Lucknow, Uttar Pradesh, India
  • Sirisha Anne Department of Obstetrics and Gynecology, Command Hospital Lucknow, Uttar Pradesh, India
  • Prema Godi Department of Obstetrics and Gynecology, Command Hospital Lucknow, Uttar Pradesh, India




Endometrial polyps, Hysteroscopy, Post-menopausal bleeding


Background: Menopause is defined according to WHO as the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. It is defined as uterine bleeding occurring after at least 1 year of amenorrhoea. Considering the high accuracy of hysteroscopy in evaluation of postmenopausal bleeding, the present study was carried out with an aim to evaluate hysteroscopic findings in women with postmenopausal bleeding in order to assess the causes of PMB and to determine their prevalence in our population.

Methods: This was a prospective observation study, comprising of total number of 50 postmenopausal women attending gynae OPD at department of obstetrics and gynecology, Command Hospital (CH), Lucknow, Uttar Pradesh. The data obtained for the purpose of study was fed into computer using Microsoft excel 2013 software.

Results: A total of 50 women with complaints of postmenopausal bleeding were enrolled in the study. Maximum number of women had achieved menopause between age 46 and 50 years. Hysteroscopy had an accuracy of 94% for detection of polyps. Hysteroscopy had an accuracy of 90% for detection of atrophy. For fibroid, hysteroscopy had an absolute sensitivity, specificity, positive predictive, negative predictive and accuracy value (100%).

Conclusions: The findings of present study suggested that hysteroscopy has a useful role in evaluation of postmenopausal bleeding especially in the diagnosis of polyps and fibroids. Given fewer number of cases, the usefulness of hysteroscopy in evaluation of endometrial cancer and hyperplasia could not be established adequately. Further studies on larger number of sample size will help in providing more useful and confirmatory information.


Research on the menopause in the 1990s: report of a WHO scientific group. WHO Tech Report Series. 1996;866:1-107.

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

Ribeiro CT, Rosa-E-Silva JC, Silva-de-Sá MF, Rosa-E-Silva AC, Poli Neto OB, Candido Dos Reis FJ, et al. Hysteroscopy as a standard procedure for assessing endometrial lesions among postmenopausal women. Sao Paulo Med J. 2007;125:338-42.

Metello J, Relva A, Milheras E, Colaço J, Retto H. Hysteroscopic diagnostic accuracy in post-menopausal bleeding. Acta Med Port. 2008;21:483-8.

Cordeiro A, Condeco R, Leitao C, Sousa F, Coutinho S, Silva MC, et al. Office hysteroscopy after ultrasonographic diagnosis of thickened endometrium in postmenopausal patients. Gynecol Surg. 2009;6:317.

Tinelli R, Tinelli FG, Cicinelli E, Malvasi A, Tineli A. The role of hysteroscopy with eye-directed biopsy in postmenopausal women with uterine bleeding and endometrial atrophy. Menopause. 2008;15(4 Pt 1):737-42.

Tandulwadkar S, Deshmukh P, Lodha P, Agarwal B. Hysteroscopy in postmenopausal bleeding. J Gynecol Endosc Surg. 2009;1(2):89-93.

Nagalakshmi M, Malathi P, Sowjanya A. Evaluation of postmenopausal bleeding by using Pipelle curette and hysteroscopic-guided biopsy: a comparative study. J. Evid. Based Med. Healthc. 2016;3(74):4028-33.

Junnare KK, Desai GJ, Shekhawat GS. Hysteroscopy: an effective tool in post-menopausal bleeding. Int J Reprod Contracept Obstet Gynecol. 2019;8(1):159-64.

Viswanathan M, Daniel S, Shailaja M, Nazeema A. Socio-demographic profile of patients with postmenopausal bleeding attending out-patient unit of a tertiary care centre. Sch J App Med Sci. 2014;2(2C):681-4.

Sindhuri R, Dongre AR. Postmenopausal bleeding among rural women in Tamil Nadu, India: Mixed methods study. Indian J Community Med. 2018;43:288-93.

Cappelletti M, Wallen K. Increasing women's sexual desire: The comparative effectiveness of estrogens and androgens. Horm Behav. 2016;78:178-93.

Roeca C, Al-Safi Z, Santoro N. The Postmenopausal Women. InEndotext. MDText. com, Inc.; 2018.

Izetbegovic S, Stojkanovic G, Ribic N, Mehmedbasic E. Features of postmenopausal uterine haemorrhage. Med Arch. 2013;67(6):431-4.

Breijer MC, Timmermans A, van Doorn HC, Mol BWJ, Opmeer BC. Diagnostic strategies for postmenopausal bleeding. Obstet Gynecol Inter. 2010;Article ID 850812:1-5.

Jimenez AR, Rolon M del MR, Eyzaguirre E, Clement C. Vaginal bleeding as initial presentation of an aggressive renal cell carcinoma: a case report and review of the literature. Case Reports Pathol. 2018;Article ID 2109279:1-4.

Oriel KA, Schrager S. Abnormal uterine bleeding. Am Fam Physician. 1999;60(5):1371-80.

Bronz L, Dreher E, Almendral A, Studer A, Haller U. Guideline for the diagnosis of postmenopausal bleeding. PMPB Working Group of the SGGG. Gynakol Geburtshilfliche Rundsch. 2000;40(2):71-9.

Dutta A, Farrakh S, Rajasekar S. Postmenopausal bleeding: a blessing in disguise. J Clin Gynecol Obstet. 2014;3(4):141-2.

Gupta S, Sanyal P, Dasgupta S, Sarkar D, Das T, Mandal DD, et al. The ideal investigative method for evaluation of abnormal uterine bleeding in peri and post-menopausal women. J Evolut Med Dent Sci. 2015;4(17):2878-84.

Sarvi F, Alleyassin A, Aghahosseini M, Ghasemi M, Gity S. Hysteroscopy: a necessary method for detecting uterine pathologies in post-menopausal women with abnormal uterine bleeding or increased endometrial thickness. Turk J Obstet Gynecol. 2016;13(4):183-8.

Sharma J, Tiwari S. Hysteroscopy in abnormal uterine bleeding vs ultrasonography and histopathology report in perimenopausal and postmenopausal women. J Nepal Med Assoc. 2016;55(203):26-8.

Pop-Trajkoviü-Dinic S, Ljubic A, Kopitovic V, Antic V, Stamenovic S, Pjevic AT. The role of hysteroscopy in diagnosis and treatment of postmenopausal bleeding. Vojnosanit Pregl. 2013;70(8):747-50.






Original Research Articles