Evaluation of Causes of Post-Menopausal Bleeding: A Hospital-Based Study

Midline cerebral congenital malformations, despite their relative rarity in the general population, with their high rate of Introduction: Postmenopausal bleeding is frequent in gynecology and occurs approximately in 5% to 10% of postmenopausal women. But most of the causes of post-menopausal bleeding are benign and treated conservatively. Women with postmenopausal bleeding have a primary or secondary malignancy of about 10%. So before starting treatment malignancy must be excluded. Common malignancies among them are endometrial or cervical carcinoma and rarely, ovarian cancer. The incidence of malignancy in the postmenopausal period remains sufficiently high, so it requires immediate investigations for early diagnosis, prompt treatment, and vigilant follow-up. The objective of the study is to evaluate the causes of postmenopausal bleeding in tertiary care hospitals in Dhaka city. Methods: This retrospective study was conducted at the Department of Obstetrics and Gynecology in Delta Medical College and Hospital, Dhaka, Bangladesh. The study duration spanned 12 months from July 2022 to June 2023. The study population consisted of 72 patients who presented with postmenopausal bleeding. The sampling for this study was conducted using a consecutive sampling method. Ethical approval was obtained from the ethical review committee of the study hospital. Descriptive statistics were used to summarize the demographic and clinical characteristics of the study participants. For the statistical analysis, the Statistical Package for the Social Sciences (SPSS). Results: Among 72 cases of postmenopausal bleeding, we found 9 cases of cancer (12.50%). Among them, 2 cases were cancer of the uterine cervix and 7 cases were cancer of the uterine corpus. Benign pathology was more frequent (63 cases: 87.50%), essentially presented atrophic endometritis 15 cases(20.83%), endometrial hyperplasia without atypia27.78% cases, endometrial polyp 16.67% cases, endocervical polyp 5.56% cases, cervical polyp 8.33%, leiomyoma found in 5.53% cases and preinvasive disease about 2.78% cases. Histopathological findings in 2 cases of carcinoma cervix were invasive squamous cell carcinoma and 7cases of endometrial cancer were endometrial adenocarcinoma. Cancer increased with advanced age while the incidence of bleeding decreased with age. Within 45 to 65 years of age is more frequent to develop post-menopausal bleeding. Conclusion: Even though causes of post-menopausal bleeding are mostly benign and treated conservatively but malignancy must be ruled out by endometrial and cervical biopsy.