Frequency of Endometrial Carcinoma in Patients with Postmenopausal Bleeding

Abstract

Introduction: Postmenopausal bleeding (PMB) is defined as bleeding that occurs after 1 year of amenorrhea in a woman who is not receiving hormone replacement therapy (HRT).1 About 10% of women with postmenopausal bleeding have a primary or secondary malignancy. Common malignancies among them are endometrial cancer (80%), cervical cancer or an ovarian tumour.1 Endometrial cancer is the second most common cancer associated with hereditary non-polyposis colorectal cancer.2 Ninety percent of patients have benign causes.
Objective: The objective of this study was to determine the frequency of endometrial carcinoma in patients with post-menopausal bleeding.
Study Design: Descriptive case series study.
Setting: Department of obstetrics and gynaecology, Lady Willingdon, Lahore.
Duration of Study: This study was conducted over a period of six months from 1st January 2009 to 30th June 2009.
Subjects and Methods: 50 cases with postmenopausal bleeding.
Results: During the period of this study a total number of 50 consecutive patients who met inclusion criteria were enrolled in the study. Ages of the patients who presented with PMB ranged between 48 years and 80 years with a mean age of 59 years. Malignancy was found in 18 out of 50 cases (36%).Cases with endometrial CA were 14 out of 50 cases (28%) and CA cervix constituted 4 out of 50 cases (8%). Benign pathology was more frequent (64%). 13 of 50 cases (26%) had hyperplasia out of which 1 case (2%) was of atypical hyperplasia. Endometrial polyp was found in 4 of 50 cases (8%). 3 of 50 cases (6%) had chronic endometritis. 5 of 50 cases (10%) had chronic cervicitis. While 7 cases (14%) had postmenopausal bleeding due to decubitus ulcer of uterovaginal prolapse. Among malignancies (36%), endometrial cancer is the most frequent malignancy in women with postmenopausal bleeding with mean age of 65years.
Conclusion: In this study it was concluded that the majority of cases of PMB would be expected to be suffering from benign problems. The main aim of evaluation of cases of PMB is to exclude or identify endometrial or cervical carcinoma and atypical endometrial hyperplasia.
Key Words: Postmenopausal bleeding, menopause, endometrial carcinoma.