Ann Geriatr Med Res.  2018 Dec;22(4):189-193. 10.4235/agmr.18.0042.

Clinicopathologic Characteristics and Causes of Postmenopausal Bleeding in Older Patients

• Jo HC
• Baek JC
• Park JE
• Park JK
• Cho IA
• Choi WJ
• Sung JH

• KMID: 2439115
• DOI: http://doi.org/10.4235/agmr.18.0042

Abstract

BACKGROUND
This study aimed to reveal the clinicopathologic features and causes of bleeding in older patients with postmenopausal bleeding (PMB) and to investigate the correlation between the ultrasonographic findings and etiology of PMB.
METHODS
We retrospectively analyzed the causes and clinical characteristics of PMB in 498 patients who were diagnosed between January 2007 and December 2017. The population with PMB was divided into 2 groups according to age: Group A (n=204) included individuals more than 65 years of age and group B (n=294) included those less than 65 years of age. Clinical characteristics such as age, parity, underlying conditions, previous surgical history, and previous menopausal hormone therapy were compared between the groups. Cervical cytology testing and transvaginal ultrasonography were performed in all patients with PMB. Endometrial biopsy was performed in all cases of endometrial thickness ≥5 mm.
RESULTS
We examined 498 patients with PMB. In group A, atrophic endometrium (n=125, 61.27%) was the most common cause of PMB. Twenty-three patients had gynecological malignancy (cervical cancer: n=12, 5.88%; endometrial cancer: n=8, 3.42%; ovarian cancer: n=3, 1.46%), and 30 patients had benign gynecological disease (endometrial polyp: n=10, 4.90%; submucosal myoma: n=6, 2.94%; uterine prolapse: n=7, 3.42%; cervical dysplasia; n=5, 2.45%; cervical polyp: n=2, 0.98%). Forty patients had endometrial thickness ≥5 mm. Eight patients were diagnosed with endometrial cancer. All cases of endometrial cancer were diagnosed with endometrial thickness >10 mm.
CONCLUSION
Atrophic endometrium was the most common cause of PMB in both groups, and approximately 12% of cases were associated with gynecological malignancy in older patients.

Keyword

Postmenopause; Vaginal bleeding; Elderly

MeSH Terms

Aged
Biopsy
Endometrial Neoplasms
Endometrium
Female
Hemorrhage*
Humans
Myoma
Ovarian Neoplasms
Parity
Polyps
Postmenopause
Retrospective Studies
Ultrasonography
Uterine Hemorrhage
Uterine Prolapse