Post Menopausal Bleeding: An Analytic Study of 100 Cases

Objective To enumerate the age predilection, incidence of malignancies, clinical presentation, histopathological diagnosis and management of post menopausal bleeding. Study design A retrospective analysis of 100 cases of postmenopausal bleeding who were investigated by hysteroscopy and /or cervical biopsy between January 2014 and December 2014. The data was collected from case records and histopathology reports. Results The average age of reaching menopause was 48.5 years and in 53 % the time of onset of postmenopausal bleeding was between 5-10 years after menopause in our study population. The age range of study population was between 45 and 80 years. The peak incidence of malignancy was observed in age group of 55- 70yrs. The histopathological analysis showed proliferative endometrium (14 %), atrophic endometrium (11 %), simple hyperplasia (17 %), Complex hyperplasia with atypia (1 %), endometritis, endometrial polyp and cervical polyp in 6 %, 8 % and 3 % respectively. Conservative management was done in 28 % with atrophic endometrium, endometritis & benign endometrial or cervical polyp. Patients with proliferative endometrium, simple hyperplasia were observed for recurrent episodes by regular follow-up. Hysterectomy was done to one patient with complex hyperplasia with atypia. Incidence of cervical and endometrial carcinoma was 27 % and 12 % respectively, who were referred to oncology department for further management. Conclusion Postmenopausal bleeding is a sinister complaint. It requires careful and timely assessment to eliminate the possibility of malignancy. The risk of endometrial malignancy increases with age. Patient characteristics like nulliparity, hypertension, diabetes mellitus, obesity etc should be taken into account in the diagnostic workup along with increased endometrial thickness greater than4mm by transvaginal sonography (TVS) while considering further endometrial sampling. High cervical cancer preponderance stresses on need for education of patients regarding screening and early diagnosis.