Recurrent postmenopausal bleeding: a prospective cohort study

Paul P Smith, Siobhan O'Connor, Janesh Gupta, T Justin Clark

Research output: Contribution to journalArticlepeer-review

24 Citations (Scopus)


STUDY OBJECTIVE: To estimate the prevalence of genital tract diseases in women with initial and recurrent postmenopausal bleeding (PMB) to help inform diagnostic pathways.

DESIGN: Prospective cohort study (Canadian Task Force classification: II-2).

SETTING: Large urban teaching hospital.

PATIENTS: Of 1938 consecutive women with postmenopausal bleeding, 106 (5%) were investigated for a recurrent episode after having normal findings of previous investigations.

INTERVENTIONS: All women underwent pelvic examination and ultrasound scanning. An endometrial biopsy was performed when endometrial thickness was >4 mm in women with a first episode of PMB, with recourse to outpatient hysteroscopy after correlation between clinical and pathologic findings. All women with a recurrent PMB episode underwent endometrial biopsy and outpatient hysteroscopy.

MEASUREMENTS AND MAIN RESULTS: The risk of having endometrial cancer or hyperplasia with atypia was significantly less in women with recurrent PMB (9%) as compared with those with a first episode of PMB (8%) (p = .002), but were significantly more likely to have benign endometrial polyps (28%) compared with women with a first episode of PMB (19%) (relative risk, 1.47; 95% confidence interval, 1.07-2.02; p = .02).

CONCLUSION: Recurrent PMB results in less likelihood of premalignant and malignant endometrial disease; however, in 1 of 4 women PMB is caused by endometrial polyps. First-line investigation in women with recurrent PMB should be tests that have high accuracy for enabling diagnosis of focal diseases, such as outpatient hysteroscopy or saline infusion sonography.

Original languageEnglish
Pages (from-to)799-803
Number of pages5
JournalJournal of Minimally Invasive Gynecology
Issue number5
Early online date25 Mar 2014
Publication statusPublished - 1 Sept 2014


  • Biopsy
  • Cohort Studies
  • Early Detection of Cancer
  • Endometrial Neoplasms
  • Endometrium
  • Female
  • Hospitals, Teaching
  • Humans
  • Hysteroscopy
  • Middle Aged
  • Outpatients
  • Polyps
  • Postmenopause
  • Precancerous Conditions
  • Prevalence
  • Prospective Studies
  • Urban Population
  • Uterine Hemorrhage
  • Uterine Neoplasms


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