Interpretation of Genital Tract Bleeding and Increased Endometrial Thickness in Postmenopausal Women: A Clinical and Histopathological Study

Document Type : Original Article

Authors

1 Deapartment of Obstetrics and Gynecology, Sri Balaji Medical College and Research Institute, Tirupati, Andhra Pradesh, India

2 Department of Urology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India

Abstract

Background and aim: The present study aims to the causes of genital tract bleeding and increased endometrial thickness in postmenopausal women, their clinical presentation, and histopathological changes.
Material and methods: A Prospective study performed over one and half years from January 2021 to June 2022, including 70 postmenopausal women coming to the gynaecology out patient department (OPD) with complaints of genital tract bleeding and having increased endometrial thickness in ultrasound (USG) have taken into the study. Clinical examination, blood investigations, radiological imaging, pap smear, and endometrial biopsy were done.
Results: Among the 70 study subjects, the most common clinical presentation was postmenopausal bleeding in 63 (90%) women, and the commonest USG finding was the increased endometrial thickness > 4 mm in 56 (80%) women. The histopathological analysis showed proliferative endometrium in 21 (30.5%) women, secretory endometrium in 9 (12.9%) women, endocervicitis in 8 (11.5%) women, atrophic endometrium in 7 (10%) women, cystic glandular hyperplasia in 6 (8.6%) women, cervical malignancy in 6 (8.6%) women, endometrial hyperplasia with atypia in 5 (7.2%) women, endometrial polyp in 3 (4.2%) women and endometrial malignancy in 3 (4.2%) women and cervical polyp in 2 (2.8%) women.
Conclusions: Genital tract bleeding and increased endometrial thickness are abnormal findings in postmenopausal women, which need a thorough evaluation using history taking, clinical examination, and investigations to eliminate the possibility of malignancy as early as possible.

Keywords

Main Subjects


[1] Rees M, Abernethy K, Bachmann G, Bretz S, Ceausu I, Durmusoglu F, et al. The essential menopause curriculum for healthcare professionals: A European Menopause and Andropause Society (EMAS) position statement. Maturitas. 2022;158:70-7. https://doi.org/10.1016/j.maturitas.2021.12.001.
[2] Nasreen SZ, Mahjabeen N, Shahreen S. Postmenopausal Bleeding: An Update. European Journal of Medical and Health Sciences. 2021;3(1):28-33. https://doi.org/10.24018/ejmed.2021.3.1.652.
[3] Hebbar S, Chaya V, Rai L, Ramachandran A. Factors influencing endometrial thickness in postmenopausal women. Annals of Medical and Health Sciences Research. 2014;4(4):608-14. https://doi.org/10.4103/2141-9248.139340.
[4] Sung S, Abramovitz A. Postmenopausal Bleeding. InStatPearls [Internet]. StatPearls Publishing. 2022.
[5] Wolfman W, Leyland N, Heywood M, Singh SS, Rittenberg DA, Soucy R, et al. Asymptomatic endometrial thickening. Journal of Obstetrics and Gynaecology Canada. 2010;32(10):990-9. https://doi.org/10.1016/S1701-2163(16)34690-4.
[6] Migda M, Migda M, Migda B. EP44. 24: Assessment of risk factors for endometrial cancer diagnosed with diagnostic curettage. Ultrasound in Obstetrics & Gynecology. 2022;60(21):300. https://doi.org/10.1002/uog.25959.
[7] Goodman A. Endometrial cancer: screening, diagnosis, and surgical staging. InUterine Cancer 2016:13-23. https://doi.org/10.1007/7631_2016_14.
[8] Sousa R, Silvestre M, Sousa LA, Falcão F, Dias I, Silva T, et al. Transvaginal ultrasonography and hysteroscopy in postmenopausal bleeding: a prospective study. Acta obstetricia et gynecologica Scandinavica. 2001;80(9):856-62.
[9] Sreelatha S, Jayanthi SP, Shivananjaiah C, Malapure P, Nataraj HN. Postmenopausal bleeding and its evaluation: Prospective study in a tertiary care center. Intl J Gynecol Obstet. 2017;1(2):48-51.
[10] Kothapally K, Bhashyakarla U. Postmenopausal bleeding: clinicopathologic study in a teaching hospital of Andhra Pradesh. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2013;2(3):344-9.
[11] Wong M, Thanatsis N, Amin T, Bean E, Madhvani K, Jurkovic D. Ultrasound diagnosis of endometrial cancer by subjective pattern recognition in women with postmenopausal bleeding: prospective inter‐rater agreement and reliability study. Ultrasound in Obstetrics & Gynecology. 2021;57(3):471-7. https://doi.org/10.1002/uog.22141.
[12] Phillip H, Dacosta V, Fletcher H, Kulkarni S, Reid M. Correlation between transvaginal ultrasound measured endometrial thickness and histopathological findings in Afro-Caribbean Jamaican women with postmenopausal bleeding. Journal of Obstetrics and Gynaecology. 2004;24(5):568-72. https://doi.org/10.1080/01443610410001722671.
[13] Aravazhi M, Breetha V, Ajit R, Sruthi S. Study of histopathological findings and clinical presentation in postmenopausal Bleeding. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2022;11(3):735-9.
[14] Ding S, Madu CO, Lu Y. The impact of hormonal imbalances associated with obesity on the incidence of endometrial cancer in postmenopausal women. Journal of Cancer. 2020;11(18):5456-65. https://doi.org/10.7150%2Fjca.47580.