Postmenopausal Bleeding: Clinical Significance and Histopathological Evaluation

Normal menstruation is defined as the bleeding from secretory endometrium associated with an ovulatory cycle not exceeding a length of 5 days. Any bleeding not fulfilling these criteria is referred to as an abnormal uterine bleeding. Some of these are the result of an identifiable pathological lesion, such as endometriosis, submucous myoma, endometrial polyp, or cancer, particularly in the postmenopausal patient. The aim of the present study was to investigate the clinical significance and endometrial pathology in patients with postmenopausal bleeding (PMB) in terms of etiology, risks factors, incidence of malignancy, and histopathological evaluation. 202 cases of PMB admitted to Basrah Maternity Teaching Hospital from 1990-1999 underwent a detailed history, clinical examination and full investigation, including full laboratory investigation, pelvic ultrasound, and examination under anesthesia (EUA) with dilatation and curettage and tissue sampling. The age range of the patient was from (35 to 72 years) with a mean of (49 years). The Results showed that Benign pathology was found in (184 / 209) cases. These included senile atrophic endometrium, normal functioning endometrium, endometrial hyperplasia, endometritis, polyps, cervicitis, and cervical polyps. Malignant pathology was found in (18) cases including (8) cases of cancer of the cervix and (10) cases of adenocarcinoma of the endometrium. It is concluded that postmenopausal bleeding is an important symptom and requires careful and prompt evaluation to eliminate the possibility of malignancy as quickly as possible.