Munawar S, Kamal F, Munawar F.
Morphological Pattern Of Endometrial Lesions In Postmenopausal Bleeding.
Biomedica Jan ;34(1):10-4.

Back ground and Objectives: Abnormal uterine bleeding is common gynecological complaint and accounts approximately for 5 ? 10% of postmenopausal women. The primary or secondary malignancy in females with postmenopausal bleeding (PMB) is around 10%. Frequent malignancies amid them are ovarian cancer, endometrial cancer or cervical cancer. The incidence of malignancy in postmenopausal period remains sufficiently high so it requires immediate investigation for early diagnosis, cautious follow up and speedy treatment. Postmenopausal uterine bleeding is also seen in a considerable number of patients who come with this complaint but are actually suffering from endometrial hyperplasia. This study was designed to determine the frequency of various morphological lesions as causes of bleeding in postmenopausal women. Methods: This prospective study included 100 endometrial specimens from postmen-pausal women with bleeding over a period of 6 months in the Department of Pathology, Fatima Jinnah Medical University/Sir Ganga Ram Hospital, Lahore from 10th August, 2010 to 10th January, 2011. The specimens were subjected to gross and microscopic examination for histopathological diagnosis. Results: The most prevalent age at which postmenopausal bleeding presented was between 45-55 years group with mean age as 50.02 ± 4.5 years. Among the endometrial causes of postmenopausal bleeding benign cases had an incidence of 88% and 12% cases were malignant. Endometrial Hyperplasia was the most common among the benign causes followed by Chronic Endoemtritis. Adenocarcinoma was a major finding among the malignant causes. Among the 12% incidence of malignant cases, only 2% were of non-endometrioid type of endometrial adenocarcinoma (serous papillary type). Conclusions: Bleeding from genital tract occurring after menopause is much more sinister than premenopausal bleeding. The incidence of a malignant cause increases as the time lapse between menopause and onset of bleeding increases. Although, the incidence of postmenopausal bleeding due to malignancy has fallen, it remains sufficiently high to require immediate and thorough investigation.

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