Clinicopathological evaluation of postmenopausal bleeding: a prospective study

Introduction: Postmenopausal bleeding (PMB) accounts for 5% of gynaecological Out Patient Department presentations. Generally, 4% to 11 % of postmenopausal women will experience bleeding per vaginum. Although the chances of occurrence reduces , as time since menopause increases. About 71 million people of our population are aged over 60 years and out of these, 43 million are post menopausal women, as per the third consensus meeting of Indian Menopause Society (2008). Postmenopausal bleeding is one of the most common reason for referral to gynaecological department, with a strong suspicion of malignancy. Materials and Methods: This prospective observational study was conducted out on 75 patients at department of Obstetrics and Gynaecology Government medical college Srinagar for a period of 18 months from June 2018- December 2019. Postmenopausal women who came up with complaints of vaginal bleeding, with their last menstrual period at least one year back and who were 45 years and above. Informed consent was taken from the study subjects. Exclusion criteria for the study subjects was taken as; Patients having pre-mature menopause, Surgically induced menopause , Radiation induced menopause, Chemotherapy induced menopause. Results: In our study of 75 patients for evaluation of PMB it was found that majority of study subjects 44% had their menopause between the age of 50-54 years, 60% had menopausal bleeding between the age of 50-59 years, 41.33% were Para 2, 34.6% had associated hypertension, 16% had associated Diabetes mellitus, 37.3% were overweight , 2.6% were obese,5.3% had Hypothyroidism and 4% had no illness. Conclusion: Medical disorders like diabetes mellitus, obesity, hypertension etc are associated with higher risk of malignancy. Endometrial thickness of more than 4 mm and histopathology features of proliferative changes put a patient at high risk of malignancy. The main purpose of evaluation of post menopausal bleeding is to determine the exact cause, which in majority of the cases turns out to be benign cause, though the main worry of the clinician is premalignant and malignant leisions. Hence all the patients with post menopausal bleeding need to undergo endrometrial sampling.