Endometrial pathology in recurrent postmenopausal bleeding: observational study of 385 women

OBJECTIVES: Women with recurrent postmenopausal bleeding (PMB) are considered as being at higher risk for endometrial hyperplasia and cancer, and guidelines suggest offering hysterectomy in unexplained cases with repeated negative investigations. This study aims to determine the prevalence of endometrial pathology in women referred with recurrent PMB to help inform clinical practice.

METHODS: This was an observational study of prospectively collected data over a 5-year period, including 1902 women referred to the PMB clinic. Women were classified into two groups: those with a single referral episode (n = 1517, 79.8%), and women with multiple referrals because of recurrent PMB (n = 385, 20.2%).

RESULTS: The prevalence of endometrial hyperplasia or cancer was 32 (8.3%) in women with multiple referrals and 159 (10.5%) in those with a single referral (p = 0.21). The prevalence of benign polyps was 80 (20.8%) and 214 (14.1%) in the two groups, respectively (p = 0.002). On comparing to women with a single referral, the odds ratio (95% confidence interval) for women with multiple referrals because of recurrent PMB to have endometrial polyps was 1.6 (1.2-2.1).

CONCLUSION: Women with recurrent PMB had a higher prevalence of endometrial polyps, rather than hyperplasia or cancer, when compared with those with a single referral. Hysteroscopy may be warranted as the first-line investigation, if PMB recurs, to enable polyp diagnosis.