Recurrent postmenopausal bleeding

Thirty-four patients with recurrent postmenopausal bleeding are reviewed. All had previously undergone dilatation and curettage after a first episode of postmenopausal bleeding, and no pathological cause had been found. When they presented with recurrence of bleeding, 32 of the 34 patients underwent total abdominal hysterectomy and bilateral salpingo-oöphorectomy and the excised organs were submitted for histological examination. In 2 patients clinical cervical carcinoma was found and they received radiotherapy. Hysterectomy was warranted in 5 patients with endometrial glandular hyperplasia and in 2 with uterine fibroids. Fibroids which distort the uterine cavity can result in an inadequate curettage. In 2 patients, failure to take adequate endocervical cytology smears resulted in a pre-operative diagnosis of endocervical carcinoma being missed. In recurrent postmenopausal bleeding, the taking of an adequate cervical smear and repear dilation and curettage are indicated as initial procedures. In obese patients, in whom palpable ovarian tumours may be overlooked, and in those with distortion of the endometrial cavity due to fibroids, total abdominal hysterectomy with bilateral salpingo-oöphorectomy is preferable, because underlying genital cancer can be missed in these cases.