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Submitted
16 October 2023
Accepted
19 February 2024
Published
10 March 2024
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Abstract

Highlights:


1. Malignancies in postmenopausal bleeding are not very common, yet it is necessary to evaluate the etiology and implement appropriate treatment strategies.
2. The findings of this study highlight the need for early detection of benign, premalignant, or malignant cases to provide more effective management, prevent the development of cancer, and improve the prognosis of the condition. 


Abstract


Bleeding from the genital organ after a year of menopause is called postmenopausal bleeding. The causes may be either benign or malignant, originating from genital (uterine or extrauterine) and extragenital sites. About 3% of postmenopausal women suffer from uterine cancer. This present study aimed to analyze the clinical significance of postmenopausal bleeding concerning the source, associated risk factors, and various endometrial pathologies, including malignant and premalignant conditions. This retrospective study was conducted over four years and featured postmenopausal bleeding patients who met the inclusion criteria. Different causes of bleeding were noted and managed. Data collection on the history, clinical examination, blood test, and endometrial biopsy was performed on women with endometrial bleeding. The collected data were analyzed using standard descriptive statistics and presented using frequency tables. A total of 88 women were admitted, of whom 73 (82.95%) had endometrial bleeding and 15 (17.05%) experienced bleeding from other sites. The endometrial bleeding group mostly consisted of women aged >50–60 years (45.20%). Hypertension (26.03%), diabetes (21.91%), obesity (43.83%), and nulliparous (5.48%) were the risk factors present among the patients. The majority of the patients (41.10%) were within five years of menopause. The transvaginal ultrasound findings indicated that 56.16% of the women had an endometrial thickness of >10 mm, while 9.59% had an endometrial thickness of ≤4 mm. Upon histological investigation, endometrial hyperplasia (34.24%), atrophy (38.36%), and cancer (4.11%) were detected. Furthermore, a prevalence of 16.44% was identified as proliferative endometrium, whereas polyps were found in 6.84% of cases. In conclusion, postmenopausal bleeding is mostly benign, but it may raise concerns about the possibility of malignancy, which can be distressing for women. Disregarding the amount and frequency, postmenopausal bleeding requires a thorough evaluation, primarily because adequate management can prevent the progression of many premalignant cases to be endometrial cancer. 

Keywords

Postmenopausal bleeding transvaginal scanning endometrial thickness histopathology cancer

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Author Biographies

Basanta Manjari Hota, Department of Obstetrics and Gynecology, Mamata Medical College, Khammam, India

Senior Resident, Department of Obstetrics & Gynecology, Mamata Medical college, Khammam, Telangana, India, PIN-507002

Kavitha Bakshi, Department of Obstetrics and Gynecology, Mamata Medical College, Khammam, India

Professor,

Department of Obstetrics & Gynecology,

 

Geetha Lokam, Department of Obstetrics and Gynecology, Mamata Medical College, Khammam, India

Associate Professor

Department of Obstetrics & Gynecology.

Naimisha Movva, Department of Obstetrics and Gynecology, Mamata Medical College, Khammam, India

Associate Professor,

Department of Obstetrics & Gynecology.

How to Cite
Basanta Manjari Hota, Bakshi, K. . ., Lokam, G. ., & Movva, N. . (2024). Clinicopathological Analysis of Postmenopausal Bleeding and Endometrium. Folia Medica Indonesiana, 60(1), 1–7. https://doi.org/10.20473/fmi.v60i1.50539
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References

  1. Agrawal M, Kotpalliwar MK, Kotpalliwar S (2018). Clinicopathological evaluation of postmenopausal bleeding. International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, 5076. doi: 10.18203/2320-1770. ijrcog20184970.
  2. American Cancer Society (2019). Endometrial cancer causes, risk factors, and prevention. cancer.org. Available at: https://www.cancer.org/ c ontent/dam/CRC/PDF/Public/8610.00.pdf.
  3. American College of Obstetricians and Gynecologists (2018). ACOG committee opinion No. 734: The role of transvaginal ultrasonography in evaluating the endometrium of women with postmenopausal bleeding. Obstetrics & Gynecology 131, 124–129. doi: 10.1097/AOG.0 000000000002631.
  4. Begum J, Samal R (2019). A clinicopathological evaluation of postmenopausal bleeding and its correlation with risk factors for developing endometrial hyperplasia and cancer: A hospital-based prospective study. Journal of Mid-life Health 10, 179. doi: 10.4103/jmh.JMH_136_18.
  5. Breijer MC, Visser NCM, van Hanegem N, et al (2016). A structured assessment to decrease the amount of inconclusive endometrial biopsies in women with postmenopausal bleeding. International Journal of Surgical Oncology 2016, 1–5. doi: 10.1155/2016/3039261.
  6. Goldstein SR (2018). Appropriate evaluation of postmenopausal bleeding. Menopause 25, 1476–1478. doi: 10.1097/GME.0000000000001181.
  7. Gopalakrishna N, Fernandes J, Surjan P, et al (2022). Clinicopathological study of postmeno pausal bleeding in a tertiary hospital: a retrospective analysis. International Journal of Reproduction, Contraception, Obstetrics and Gynecology 11, 2634. doi: 10.18203/2320-1770.ij rcog20222455.
  8. Kothapally K, Bhashyakarla U (2013). Postmenopausal bleeding: clinicopathologic study in a teaching hospital of Andhra Pradesh. International Journal of Reproduction, Contra ception, Obstetrics and Gynecology 344–348. doi: 10.5455/2320-1770.ijrcog20130916.
  9. Mahdy H, Casey MJ, Crotzer D (2024). Endometrial cancer. Available at: http://www.ncbi.nlm.nih.gov /pubmed/29644661.
  10. Mallick A, Behera R, Subudhi K (2013). Histopathological study of endometrium in postmenopausal bleeding. Journal of Evolution of Medical and Dental sciences 2, 9010–9018. doi: 10.14260/jemds/1564.
  11. Microsoft Corporation (2016). Microsoft Excel, Available at: https://office.microsoft.com/excel.
  12. Muzaffar U, Maraj-ud-din (2020). Clinicopatholo gical evaluation of postmenopausal bleeding: A prospective study. International Journal of Current Research 12, 11841–11844. doi: 10.24941/ijcr.38 942.06.2020.
  13. Nirupama V, Suneetha Y, Devi P (2013). Post menopausal bleeding: An analytic study of 100 cases. International Journal of Science and Research (IJSR) 4, 2588–2590. Available at: https://www.ijsr.net/archive/v4i6/SUB155971.pdf
  14. Otify M, Fuller J, Ross J, et al (2015). Endometrial pathology in the postmenopausal woman – an evidence based approach to management. The Obstetrician & Gynaecologist 17, 29–38. doi: 10.1111/tog.12150.
  15. Potikul C, Tangjitgamol S, Khunnarong J, et al (2016). Uterine sarcoma: Clinical presentation, treatment and survival outcomes in Thailand. Asian Pacific Journal of Cancer Prevention 17, 1759–1767. doi: 10.7314/APJCP.2016.17.4.1759.
  16. Rathi S, Sangeeta K, Manisha K (2013). Histopathological evaluation in women with postmenopausal bleeding and associated risk factors for endometrial carcinoma. Journal of Evolution of Medical and Dental sciences 2, 4397–4402. doi: 10.14260/jemds/852,
  17. Rita D, Kumar S, Ritshesh S (2016). The clinicopathological study of postmenopausal bleeding. International Journal of Reproduction, Contraception, Obstetrics and Gynecology 3671–3674. doi: 10.18203/2320-1770.ijrcog20163829.
  18. Sharma AK, Yerrapragada M (2022). Clinicopatho logical study of postmenopausal bleeding in a tertiary care Hospital, Udaipur, Rajasthan. International Journal of Scientific Research 76–77. doi: 10.36106/ijsr/0711156.
  19. Singh P, Dwivedi P, Mendiratta S (2016). Correlation of endometrial thickness with the histopathological pattern of endometrium in postmenopausal bleeding. The Journal of Obstetrics and Gynecology of India 66, 42–46. doi: 10.1007/s13224-014-0627-z.
  20. Singh V, Nath S, Mohanta C (2017). Clinicopatho logical study of postmenopausal bleeding. International Journal of Advanced Research 5, 408–421. doi: 10.21474/IJAR01/3825.
  21. Smith PP, O'Connor S, Gupta J, et al (2014). Recurrent postmenopausal bleeding: A prospec tive cohort study. Journal of Minimally Invasive Gynecology 21, 799–803. doi: 10.1016/j.jmig. 2014.03.007.
  22. Sravanthi J (2020). Clinical evaluation of postmenopausal bleeding at a tertiary care center. MedPulse International Journal of Gynaecology 14, 70–73. doi: 10.26611/10121431.
  23. Su D, Li L, Zhong M, et al (2021). Capacity of endometrial thickness measurement to diagnose endometrial carcinoma in asymptomatic post menopausal women: a systematic review and meta-analysis. Annals of Palliative Medicine 10, 10840–10848. doi: 10.21037/apm-21-2516.
  24. Sur D, Chakravorty R (2016). Correlation of endometrial thickness and histopathology in women with abnormal uterine bleeding. Reproductive System & Sexual Disorders. doi: 10.4172/2161-038X.1000192.
  25. Talari K, Goyal M (2020). Retrospective studies – Utility and caveats. Journal of the Royal College of Physicians of Edinburgh 50, 398–402. doi: 10.4997/jrcpe.2020.409.
  26. Ubeja A, Singh A (2017). Clinicopathological evaluation of postmenopausal bleeding in rural hospital set up. International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, 3556. doi: 10.18203/2320-1770.ijrcog20173483.
  27. Vetter TR (2017). Descriptive statistics: Reporting the answers to the 5 basic questions of who, what, why, when, where, and a sixth, so what? Anesthesia & Analgesia 125, 1797–1802. doi: 10.1213/ANE.0000000000002471.
  28. Walke V, Shravan Datar S, Kowe B (2020). Endometrial pathology in postmenopausal women: Analysis of 112 cases in tertiary care centre. Panacea Journal of Medical Sciences10, 264–268. doi: 10.18231/j.pjms.2020.054.
  29. Xu X, Chen L, Nunez-Smith M, et al (2023). Timeliness of diagnostic evaluation for postmenopausal bleeding: A retrospective cohort study using claims data ed. Cowley H. PLoS One 18. doi: 10.1371/journal.pone.0289692.