• Nasira Sabiha Dawood
  • Kiran Peter
  • Faiza Ibrar
  • Asif Dawood


Background: Postmenopausal bleeding (PMB) is bleeding occurring after 6–12 months ofamenorrhea in a woman of age where the menopause can be expected. Objectives of this study wereto ascertain various causes and prevalence of genital organ malignancy in patients presenting withpostmenopausal bleeding. Methods: A prospective observational study carried out in the Departmentof Obstetrics and Gynaecology, Fauji Foundation Hospital, Rawalpindi comprising of 167consecutive cases presenting with postmenopausal bleeding one year after menopause. Womenhaving undergone hysterectomy and bilateral salpingo-oophorectomy, receiving radiotherapy orchemotherapy, suffered trauma to the genital tract, having coagulation disorder or on anticoagulantor hormone replacement therapy were excluded. Detailed history was obtained and a thoroughclinical examination was conducted. Data were entered into hospital computer database (Medix™)system. Mean±SD were calculated for age, percentage was calculated for types of histopathologicalfindings. Results: The commonest cause of PMB was atrophic endometritis and vaginitis 33(21.2%). Overall incidence of various genital tract malignancies was 25 (16.0%). Conclusion: Theoverall incidence of genital tract malignancies in patients presenting with PMB is high (16.0%),therefore, it needs to be taken seriously and requires prompt and thorough investigations.Keywords: Bleeding, postmenopausal, female genital tract, malignancies, prevalence, aetiology


Research on the menopause in the 1990s: report of a WHO

scientific group. WHO Tech Report Series 1996; 866:1–107.

Breijer MC, Timmermans A, van Doorn HC, Mol BW, Opmeer

BC. Diagnostic strategies for postmenopausal bleeding. Obstet

Gynecol Int 2010;2010:850812.

Kaur M, Singh R, Sharma M. Endovaginal sonographic

evaluation of postmenopausal uterine bleeding. Journal of

Clinical and Diagnostic Research. 2010;(4):2175–82.

Brand AH. The woman with postmenopausal bleeding. Aust

Fam Physician 2007;36(3):116–20.

Astrup K, Olivarius NDF. Frequency of spontaneously occurring

postmenopausal bleeding in the general population. Acta Obstet

Gynecol Scand 2004;83:203–7.

Hill K. The demography of menopause. Maturitas


Samartzis S, Hauser GA. Postmenopausal bleeding (author’s

transl). Geburtshilfe Frauenheilkd 1976;36:326–33.

Ohler MK, Mackenzie J, Kehoe S, Rees MC. Assessment of

abnormal bleeding in menopausal women: an update. J Br

Menopause Soc 2003;9:117–21.

Gambrell RD Jr, Castaneda TA, Ricci CA. Management of

postmenopausal bleeding to prevent endometrial cancer.

Maturitas 1978;1(2):99–106.

J Ayub Med Coll Abbottabad 2010;22(2)

Luiz DA, Moodley J, Richards A. Aetiology of postmenopausal

bleeding in black women in Durban. S Afr Med J 1986;69:674–5.

Gerber B, Krause A, Muller H, Reimer T, Kulz T, Makovitzky J,

et al. Effects of adjuvant tamoxifen on the endometrium in

postmenopausal women with breast cancer: a prospective longterm study using transvaginal ultrasound. J Clin Oncol


Angioni S, Loddo A, Milano F, Piras B, Minerba L, Melis GB.

Detection of benign intracavitary lesions in postmenopausal

women with abnormal uterine bleeding: a prospective

comparative study on outpatient hysteroscopy and blind biopsy. J

Minim Invasive Gynecol 2008;15(1):87–91.

Guruwadayarhalli B, Jones SE and Srinivasan V. Hysteroscopy

in the diagnosis of postmenopausal bleeding. Menopause Int


Buchanan EM, Weinstein LC, Hillson C. Endometrial cancer.

Am Fam Physician 2009;80:1075–80.

Lin HH, Wu MY, Shyu MK, Chen D, Tsai JL, Hsieh CY.

Clinical study of 381 postmenopausal bleeding patients. J

Formos Med Assoc 1993;92:241–4.

Ferrazzi E, Torri V, Trio D, Zannoni E, Filiberto S, Dordoni D.

Sonographic endometrial thickness: a useful test to predict

atrophy in patients with postmenopausal bleeding. An Italian

multicenter study. Ultrasound Obstet Gynecol 1996;7:315–21.

Bree RL, Bowerman RA, Bohm-Velez M, Benson CB, Doubilet

PM, DeDreu S, Punch MR. US evaluation of the uterus in

patients with postmenopausal bleeding: A positive effect on

diagnostic decision making. Radiology 2000;216:260–4.

Moodley M, Roberts C. Clinical pathway for the evaluation of

postmenopausal bleeding with an emphasis on endometrial

cancer detection. J Obstet Gynaecol 2004;24:736–41.

Alcazar JL, Galvan R. Three-dimensional power Doppler

ultrasound scanning for the prediction of endometrial cancer in

women with postmenopausal bleeding and thickened

endometrium. Am J Obstet Gynecol 2009;200(1):44.e1–6.

Dangal G. A study of endometrium of patients with abnormal

uterine bleeding at Chitwan Valley. Kathmandu Univ Med J


Escoffery CT, Blake GO, Sargeant LA. Histopathological

findings in women with postmenopausal bleeding in Jamaica.

West Indian Med J 2002;51:232–5.

de Albuquerque Neto LC, Sartori MG, Baracat EC, Girão MJ, de

Lima GR. Postmenopausal genital bleeding. Sao Paulo Med J


Burbos N, Musonda P, Giarenis I, Shiner AM, Giamougiannis P,

Morris E, et al. Age-related differential diagnosis of vaginal

bleeding in postmenopausal women: a series of 3047

symptomatic postmenopausal women. Menopause Int


Lee WH, Tan KH, Lee YW. The aetiology of postmenopausal

bleeding--a study of 163 consecutive cases in Singapore.

Singapore Med J 1995;36(2):164–8.

Suckling J, Lethaby A, Kennedy R. Local oestrogen for vaginal

atrophy in postmenopausal women. Cochrane Database Syst Rev


Caspi E, Perpinial S, Reif A. Incidence of malignancy in Jewish

women with postmenopausal bleeding. Isr J Med Sci


Sahdev A. Imaging the endometrium in postmenopausal

bleeding. BMJ 2007;334:635–6.

Goodman MT, Hankin JH, Wilkens LR, Lyu LC, McDuffie K,

Liu LQ, et al. Diet, body size, physical activity, and the risk of

endometrial cancer. Cancer Res 1997;57:5077–85.

Gredmark T, kvint S, Havel G, Mattsson LA. Histopathological

findings in women with postmenopausal bleeding pv. Br J Obstet

Gynaecol 1995;102:133–6.

Dawood NS, Peter K, Sultana N, Mubarik A. Clinico-pathlogical

pattern of gynaecological malignancies amongst families of exservicmen. J Med Sci 2009;17(2):95–8.

Hamilton W, Peters TJ, Bankhead C, Sharp D. Risk of ovarian

cancer in women with symptoms in primary care: population

based case-control study. BMJ 2009;339:b2998.

al-Rufaie HK, Rix GH, Pérez Clemente MP, al-Shawaf T.

Pinworms and postmenopausal bleeding. J Clin Pathol


Androutsopoulos G, Adonakis G, Ravazoula P, Kourounis G.

Primary malignant melanoma of the vagina: a case report. Eur J

Gynaecol Oncol 2005;26:661–2.

Clarke JF. Urethral metastasis from a presumed primary

malignant melanoma presenting as postmenopausal bleeding.

Proc R Soc Med 1975;68:227–8.

Garcia M, Romaguera RL, Gomez-Fernandez C. A hydatidiform

mole in a postmenopausal woman. A case report and review of

the literature. Arch Pathol Lab Med 2004;128:1039–42.

Omoniyi-Esan GO, Badmos KB, Adeyemi AB, Rotimi O.

Leiomyosarcoma of the uterus: a clinicopathological report of

two cases and review of literature. Afr J Med Med Sci


Pearce KF, Nolan TE. Endometrial sarcoidosis as a cause of

postmenopausal bleeding. A case report. J Reprod Med


Júlio C, Amaral N, Biscaia I, Torrezão I, Fatela A. Genital

tuberculosis: a rare cause of postmenopausal bleeding. Acta Med

Port 2010;23:723–6.

Güngördük K, Ulker V, Sahbaz A, Ark C, Tekirdag AI.

Postmenopausal tuberculosis endometritis. Infect Dis Obstet

Gynecol 2007;2007:27028.

Panda JK. One-stop clinic for postmenopausal bleeding. J

Reprod Med 2002;47:761–6.



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