Management of postmenopausal bleeding to prevent endometrial cancer

The primary goal in management of postmenopausal bleeding is to insure that no malignancy is present. In this study of 3,682 climacteric women, 340 patients (9.2%) presented with postmenopausal bleeding during an 18-mth period. The pathology at curettage was reported as normal endometrium in 33.8%, atrophic endometrium in 24.7%, and hyperplasia in 39.1%. Adenocarcinoma of the endometrium was diagnosed in only 5 patients (1.5%), a reduction from 3.0% found in a previous study performed in 1972-1973. The second goal in management of postmenopausal bleeding is to identify and treat those patients with endometrial hyperplasia since this is a precancerous lesion. Cyclic progestogens were given to 105 of 133 women with hyperplasia of the endometrium for 3-6 mth and curettage repeated. The hyperplasia reverted to normal endometrium in 101 of the 105 patients (96.2%). In those 4 women with persistent hyperplasia after progestogen therapy, a hysterectomy was performed. Hysterectomy was the primary therapy for 20 women with hyperplasia because of associated findings such as leiomyomata uteri. The incidence of curettage was highest in the untreated women (23.2%), lowest in the estrogen-progestogen users (3.9%) and indicated in 14.2% of those patients receiving estrogens alone.