Investigations for postmenopausal uterine bleeding: special considerations for endometrial volume

Postmenopausal bleeding is a clinically important complaint in general gynecologic practice. The incidence of spontaneous postmenopausal bleeding in the general population is approximately 10 % immediately after menopause, and 5 % in all menopausal women.

The study was aimed to reveal the histopathologic diagnosis of postmenopausal uterine bleeding, and to investigate the correlation between various clinical factors and endometrial carcinoma. We also evaluated the role of endometrial volume calculation in the clinical use for the endometrial histopathologic findings.

In this prospective observational study, we recruited 163 postmenopausal women with abnormal uterine bleeding from January 2008 through December 2010. Women who had hematologic disease, or had nonuterine pelvic diseases were excluded. Clinical characteristics such as age, body mass index (BMI), associated diseases, and previous postmenopausal hormone therapy were checked. They were evaluated by transvaginal ultrasonography and underwent endometrial biopsy for the endometrial histopathologic examination.

Among the endometrial histopathologic findings, atrophic endometrium was the most common finding (32.7 %), followed by hyperplastic endometrium (10.4 %), endometrial carcinoma (10.4 %), and endometrial polyp (9.2 %). The prevalence of endometrial hyperplasia and cancer was not significantly different at the 5 mm cut-off thickness of the endometrium, but significantly higher in women with ≥ 3 mL of endometrial volume. However, the incidence of endometrial cancer and hyperplasia in women with endometrial bleeding was not significantly different with or without previous or current hormone therapy.

Endometrial biopsy should be performed to exclude endometrial hyperplasia and carcinoma in postmenopausal women with endometrial bleeding to perform proper and prompt treatment, especially in old aged women (> 60 years) and in patients with endometrial volume ≥ 3 mL.