The objective of this study is to assessment the postmenopausal bleeding (PMB), and investigated their causes, correlation with variable socio-demographic status. A 140-women complaining of PMB were enrolled in this study, each patient had a proper questionnaire filled in, with appropriate investigations that included; ultrasonography, Pap smear, colposcopy with cervical biopsy and endometrial curettage to take endometrial biopsy for histopathology. Nearly all cases were married 135 (96.4%), most of them were obese and overweight 97(69.3%), 43(30.7%) were having normal body mass index. Various etiology of PMB were found in this study; endometrial cancer (9.3%), cervical cancer (0.7%), atrophic endometritis (7.1%), atrophic vaginitis (2.8%), endometrial hyperplasia (45%), Cervicitis-CIN (15.7%), cervical polyp (12.8%), and endometrial polyp (18.6%). Bleeding from benign causes and of endometrial cancer occurs at fifth decade and sixth decade of life, while from cervical cancer occurs at seventh decade. The pattern of PMB; mild bleeding significantly higher in cervicitis-CIN; moderate bleeding more in endometrial polyp and significantly higher than mild and sever bleeding; while severe bleeding was significantly associated in endometrial cancer. Duration of PMB had a vast range (4 days to 5 years). 24.83% of cases had prolonged bleeding > 6months, (48.7%) with endometrial hyperplasia, (12.8%) had endometrial cancer. The endometrial cancer present in 10% of the patients with recurrent PMB.
Keywords: Postmenopausal bleeding; Endometrial cancer; Colposcopy
Copyright © 2016 by The American Society for BioMedicine and BM-Publisher, Inc.
- Panay N. Menopause & the postmenopausal women. Dewhurst’s text book of Obstetrics & Gynecology for post graduate. Blackwell, 7th edition 2007;47:479-495.
- Kaur M, Singh R, Sharma M. Endovaginal sonographic evaluation of postmenopausal uterine bleeding. Journal of Clinical and Diagnostic Research 2010;4:2175- 82.
- Decherny A, Nathen L, Goodwin T, Lawfer N. Complications of menstruation; abnormal uterine bleeding. Current Obstetrics &Gynecology diagnosis & treatment, Lang 10th edition 2007;35:577-578.
- Bhatla N. Abnormal &excessive uterine bleeding. Jeffcott’s principle of gynecology. Arnold, International edition 2001, pp. 32,109,486,579.
- Drife J, McGowan B. Uterine cancer. Clinical Obstetrics & Gynecology. Saunders, 1st edition 2004; 27:265-270.
- Anon. Endometrial bleeding. Hum Reprod update 2007;13:421-431.
- Astrup K, Olivarus Nde F. Frequency of spontaneously occurring postmenopausal bleeding in the general population. Acta Obstet Gynecol Scand 2004;83:203.
- Gredmark T, Kvint S, Havel G, Mattsson LA. Histopathological findings in women with postmenopausal bleeding. Br J Obstet Gynecol 995;102:133-136.
- Munot S, Lane G. Modern mangment of postmenopausal bleeding. Trends in Urology Gynaecology & Sexual Health September/October 2008.
- Newell S, Overton C. PMB should be referred urgently.The practioner 2012;1749:13-15.
- Wong S. Could it be cancer? investigating postmenopausal bleeding. Women's Health Journal, Primary Care 2012;4;3.
- Tabor A, Watt HC, Wald NJ. Endometrial thickness as a test for endometrial cancer in women with postmenopausal vaginal bleeding. Obstet Gynecol 2002;99:663-670.
- Goldstein RS. The role of transvaginal ultrasound or endometrial biopsy in the evaluation of the postmenopausal endometrium. Am J Obstet Gynecol 2009;201:5-11.
- Munro MG. Investigation of women with postmenopausal uterine bleeding: clinical practice recommendations. The permanente journal /Winter 2014;18:55-70.
- Sahdev A. Imaging the endometrium in postmenopausal bleeding. BMJ 2007;334(7594):635-636.
- Smithnew-Bindman R, Weiss E, Feldstein V. How thick is too thick? When endometrial thickness should prompt biopsy in postmenopausal women without vaginal bleeding. Ultrasound Obst. Gynecol 2004 Oct; 24(5):558-565.
- Grainger R G, Allison D J. Gynecological imaging. Grainger and Allison’s Diagnostic radiology. Churchill Livingstone, 5th edition 2008;54:1096-1264.
- Goldstein RB, Bree RL, Benson CB, et al. Evaluation of the woman with postmenopausal bleeding: Society of Radiologists in Ultarsound-Sponsored Consensus Conference statement. J Ultasound Med 2001;20(10):1025-1036.
- APGO educational series on women’s health issues. Clinical management of abnormal uterine bleeding. Association of professors of gynecology and obstetrics, annual report May 2002.
- Jiménez -Ayala M, Jiménez-Ayala B. Cytology of the normal endometrium-cycling and postmenopausal. Endometrial adenocarcinoma, prevention and early diagnosis. Karger 2008;6:32-39.
- Sheikh M, Swahney S, Khurana A, AL-Yatama M. Alteration of sonographic texture of the endometrium in postmenopasusal bleeding. A guide to further management. Acta Obstet Gynecol Scand 2000;79:1006.
- Van Doorn LC, Dijkhuizen FP, Kruitwagen RF, et al. Accuracy of transvaginal ultrasonography in diabetic or obese women with postmenopausal bleeding. J Obstet Gynecol 2004;104:571.
- Moodley M, Roberts C. Clinical pathway for the evaluation of postmenopausal with an emphasis on endometrial cancer detection. J Obstet Gynecol 2004;24:746-741.
- Epstien E, Jamei B, Lindqvist PG. High risk of cervical pathology among women with postmenopausal bleeding and endometrium <or =4.4mm: long-term follow up results. Acta Obstet Gynecol Scand 2006;85:1368-1374.
- Sasieni P, Adams J, Cuzick J. Benefit of cervical screening at different ages: evidence from the UK audit of screening histories. Br J Cancer 2003;89:88-93.
- Moohamed W, Thanoon M, Al-Jawadi SI. Histopathological interpretation of AUB after age of 40Year. The Iraqi postgraduate medical Journal 2010;9:3.
- Gredmark T, Kvint S, Havel G, Mattsson LA. Histopathological findings in women with postmenopausal bleeding. Br J Obstet Gynecol 1995;102:133-136.
- Clinical Practice Recommendations. The permanente journal /Winter 2014;18:55-70.
- Naik V, Rege J, Jashnani KD. Pathology of genital tract in postmenopausal bleeding. BHJ Magazine
- Parkin D. Cancer attributable to reproductive factors in UK in 2010. Br J Cancer 2011;105:(S2)S73-S76.
- Parazzini F, Vecchia CL, Negri E, Fedel L, Balotta F. Reproductive factors and risk of endometrial cancer. Am J obstet gynaecol 1991;164:522-27
- Izetbegovic S, Stojkanovic G, Ribic N, Mehmedbasic E. Features of postmenopausal Uterine Haemorrage. Medical Archives 2013;67(6):431.
- Musonda P, Burbos N, Duncan TJ, Crocker SG, Morris EP, Nieto JJ. Comparing the performance of two clinical models in estimating the risk of endometrial cancer in symptomatic postmenopausal women. European Journal of Obstetric &Gynecology&Reproductive Biology 2011;159(2):433-438.
- Schmeler KM, Lynch HT, Chen LM, Munsell MF, Soliman PT, Clark MB, et al. Prophylactic surgery to reduce the risk of gynecologic cancers in the Lynch syndrome. N Engl J Med 2006;354:261–9.
- Berek JS, Rinehart RD, Hillard PJA, et al. Novak's Gyneacology. 13 th edition.Lippincott Williams&Wilkins 2002:1144-1148.
- Saltzman BS, Doherty JA, Hill DA, et al. Diabetes and endometrial cancer:An evaluation of the modifying effects of other known risk factors. American Journal of Epidemiology 2008;167(5):607-614.
- Jillani K, Khero R, Maqsood S, et al. Prevalence of malignant disorder in 50 cases of PMB. J Pack Med Assoc 2010;60:540-543.
- Escoffery CT, Blake GO, Sargeant LA. Histopathological findings in women with postmenopausal bleeding in Jamaica. West Indian Med J 2002;51(2):232-5.
- Kothapally K, Uma Bhshyakarla. Postmenopausal bleeding:Clinicopathological study in a teaching hospital of Andhra Pradesh. International journal of reproduction, Contraception, Obestetrics and Gynaecology 2013;2:344.
- Ninci D, Mandi A, Ziki D, Stojiljkovi B, Mastilovi K, Ivikovi-Kapicl T. Neglected case of uterine leiomyoma. Case report Med Pregl 2008;61(9-10):525-8.
- Cheng W-F, Lin H-H, Torng P-L, Huang S-C. Comparison of endometrial changes among symptomatic tamoxifen treated and non- treated pre-menopausal and post-menopausal breast cancer patients. Gynecol Oncol 1997;66:233-7.
- Ronghe R, Gaudoin M. Women with recurrent postmenopausal bleeding should be re-investigated but are not more likely to have endometrial cancer. Menopause Int 2010;16(1):9-11.
READ THE FULL ARTICLE
For any technique error please contact us and will be response to sending purchase article by email.
Who Can Become a Reviewer?
Any expert in the article's research field can become a reviewer with American Journal of Biomedicine. Editors might ask you to look at a specific aspect of an article,...
Thank you for visiting American Journal of BioMedicine. * = Required fields
Received February 08, 2016; accepted June 29, 2016; published July 09, 2016
Email this link to a friend
Add article to my folders
Alert me when this article is cited
Add to portfolio
Contact with editor
Author Services Portal