Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 12 , ISSUE 6 ( November-December, 2020 ) > List of Articles

Original Article

Prevalence of Hysteroscopic Findings in Postmenopausal Bleeding Patients and Its Correlation with Clinicohistopathologic Diagnosis

Prema Godi, Pallavi Verma

Keywords : Clinicohistopathologic diagnosis, Hysteroscopy, Postmenopausal bleeding

Citation Information : Godi P, Verma P. Prevalence of Hysteroscopic Findings in Postmenopausal Bleeding Patients and Its Correlation with Clinicohistopathologic Diagnosis. J South Asian Feder Obs Gynae 2020; 12 (6):353-358.

DOI: 10.5005/jp-journals-10006-1833

License: CC BY-NC 4.0

Published Online: 12-04-2021

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: Menopause is defined as permanent cessation of menstruation, caused by ovarian failure. Average age of menopause is 52 years, with a range of 40–58 years. Women in developed world will live approximately 30 years, or greater than a third of her life, beyond menopause. Therefore, it is important to ensure these years are as healthy and productive as possible. Any amount of postmenopausal bleeding (PMB) is of great concern and it has to be evaluated thoroughly. Aim: To evaluate hysteroscopic findings in women with PMB in order to ascertain various causes of PMB and to determine their prevalence in our population and its correlation with histopathologic examination. Materials and methods: This was a prospective observation study, comprising a total number of 50 postmenopausal women attending Gyne OPD at Department of Obstetrics and Gynaecology, Command Hospital (CH), Lucknow, Uttar Pradesh, carried out over 1 year. Postmenopausal women with UV prolapse, bleeding diathesis, surgical menopause, and cardiac diseases were excluded from the study. After taking detailed history, thorough clinical examination, and informed consent, patients are subjected to transvaginal sonography followed by hysteroscopy with office hysteroscope and wherever necessary, endometrial biopsy was taken. Final diagnosis was established with the help of clinicohistopathologic workup. Results: The present study was carried out to evaluate hysteroscopically the causes of PMB. For this purpose, a total of 50 women with complaints of PMB were enrolled in the study. Age of patients ranged from 41–80 years. On hysteroscopy, half the cases (n = 25; 50%) were diagnosed as polyps followed by atrophic endometrium (n = 8; 16%). There were 7 (14%) cases in whom the cervix was classified as unhealthy without any particular diagnosis. A total of 5 (10%) cases were diagnosed as fibroid, 1 (2%) each as hyperplasia and degenerative changes, and 3 (6%) as endometrial carcinoma. These findings are well correlate with clinicohistopathologic diagnosis. Conclusion: Hysteroscopy is an office procedure that can be performed as a daycare procedure, provides a better view of various structural pathologies, and in case of a doubtful pathology, helps in obtaining endometrial sample to confirm the diagnosis.


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  1. Research on the menopause in the 1990s: report of a WHO scientific group. WHO Tech Rep Ser 1996;866:1–107. PMID: 8942292.
  2. Astrup K, Olivarius NDF. Frequency of spontaneously occurring postmenopausal bleeding in the general population. Acta Obstet Gynaecol Scand 2004;83(2):203–207. DOI: 10.1111/j.0001-6349.2004.00400.x.
  3. Ribeiro CT, Rosa-E-Silva JC, Silva-de-Sá MF, et al. Hysteroscopy as a standard procedure for assessing endometrial lesions among postmenopausal women. Sao Paulo Med J 2007;125(6):338–342. DOI: 10.1590/s1516-31802007000600007.
  4. Metello J, Relva A, Milheras E, et al. Hysteroscopic diagnostic accuracy in post-menopausal bleeding. Acta Med Port 2008;21:483–488. PMID: 19187691.
  5. Cordeiro A, Condeco R, Leitao C, et al. Office hysteroscopy after ultrasonographic diagnosis of thickened endometrium in postmenopausal patients. Gynecol Surg 2009;6(4):317. DOI: 10.1007/s10397-009-0485-3.
  6. Tinelli R, Tinelli FG, Cicinelli E, et al. The role of hysteroscopy with eye-directed biopsy in postmenopausal women with uterine bleeding and endometrial atrophy. Menopause 2008;15(4 Pt 1):737–742. DOI: 10.1097/gme.0b013e31815b644e.
  7. Tandulwadkar S, Deshmukh P, Lodha P, et al. Hysteroscopy in postmenopausal bleeding. J Gynecol Endosc Surg 2009;1(2):89–93. DOI: 10.4103/0974-1216.71614.
  8. Nagalakshmi M, Malathi P, Sowjanya A. Evaluation of postmenopausal bleeding by using Pipelle curette and hysteroscopic-guided biopsy: a comparative study. J Evid Based Med Healthc 2016;3(74):4028–4033. DOI: 10.18410/jebmh/2016/861.
  9. Junnare KK, Desai GJ, Shekhawat GS. Hysteroscopy: an effective tool in post-menopausal bleeding. Int J Reprod Contracept Obstet Gynecol 2019;8(1):159–164. DOI: 10.18203/2320-1770.ijrcog20185415.
  10. Viswanathan M, Daniel S, Shailaja M, et al. Socio-demographic profile of patients with postmenopausal bleeding attending out-patient unit of a tertiary care centre. Sch J App Med Sci 2014;2(2C):681–684. ISSN 2320-6691 (Online), ISSN 2347-954X (Print).
  11. Sindhuri R, Dongre AR. Postmenopausal bleeding among rural women in Tamil Nadu, India: mixed methods study. Indian J Community Med 2018;43(4):288–293. DOI: 10.4103/ijcm.IJCM_162_18.
  12. Cappelletti M, Wallen K. Increasing women's sexual desire: the comparative effectiveness of estrogens and androgens. Horm Behav 2016;78:178–193. DOI: 10.1016/j.yhbeh.2015.11.003.
  13. Roeca C, Al-Safi Z, Santoro N. The postmenopausal women. Endotext [Internet]; August 2018.
  14. Izetbegovic S, Stojkanovic G, Ribic N, et al. Features of postmenopausal uterine haemorrhage. Med Arch 2013;67(6):431–434. DOI: 10.5455/medarh.2013.67.431-434.
  15. Breijer MC, Timmermans A, van Doorn HC, et al. Diagnostic Strategies for Postmenopausal Bleeding. Obstetrics and Gynecology International 2010;Article ID 850812:1–5. DOI: 10.1155/2010/850812.
  16. Jimenez AR, Rolon MMR, Eyzaguirre E, et al. Vaginal bleeding as initial presentation of an aggressive renal cell carcinoma: a case report and review of the literature. Case Rep Pathol 2018;Article ID 2109279:1–4. DOI: 10.1155/2018/2109279.
  17. Oriel KA, Schrager S. Abnormal uterine bleeding. Am Fam Physician 1999;60(5):1371–1380. PMID: 10524483.
  18. Bronz L, Dreher E, Almendral A, et al. Guideline for the diagnosis of postmenopausal bleeding. PMPB Working Group of the SGGG. Gynakol Geburtshilfliche Rundsch 2000;40(2):71–79. DOI: 10.1159/000022335.
  19. Dutta A, Farrakh S, Rajasekar S. Postmenopausal bleeding: a blessing in disguise. J Clin Gynecol Obstet 2014;3(4):141–142. DOI: 10.14740/jcgo286w.
  20. Gupta S, Sanyal P, Dasgupta S, et al. The ideal investigative method for evaluation of abnormal uterine bleeding in peri and post-menopausal women. J Evol Med Dental Sci 2015;4(17):2878–2884. DOI: 10.14260/jemds/2015/416.
  21. Sarvi F, Alleyassin A, Aghahosseini M, et al. Hysteroscopy: a necessary method for detecng uterine pathologies in post-menopausal women with abnormal uterine bleeding or increased endometrial thickness. Turk J Obstet Gynecol 2016;13(4):183–188. DOI: 10.4274/tjod.66674.
  22. Sharma J, Tiwari S. Hysteroscopy in abnormal uterine bleeding vs ultrasonography and histopathology report in perimenopausal and postmenopausal women. J Nepal Med Assoc 2016;55(203):26–28. DOI: 10.31729/jnma.2834.
  23. Pop-Trajkoviü-Dinic S, Ljubic A, Kopitovic V, et al. The role of hysteroscopy in diagnosis and treatment of postmenopausal bleeding. Vojnosanit Pregl 2013;70(8):747–750. DOI: 10.2298/vsp110405004p.
  24. The American College of Obstetricians and Gynecologists. ACOG Committee opinion No. 734, May 2018.The role of transvaginal sonography in evaluating the endometrium of women with postmenopausal bleeding. Obstet Gynecol 2018;131(5):e124–e129. DOI: 10.1097/AOG.0000000000002631.
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