Frequency of the Causes of Postmenopausal Bleeding, Results of a Tertiary Referral Center in Turkey

Guler, Ismail; Nas, Tuncay; sert, Umit yasemin

doi:10.21613/GORM.2019.1007

Frequency of the Causes of Postmenopausal Bleeding, Results of a Tertiary Referral Center in Turkey

Ümit Yasemin Sert, (Sağlık Bilimleri Üniversitesi, Ankara Şehir Hastanesi, Anabilim Dalı Kadın Hastalıkları ve Doğum, Ankara, Türkiye)

Tuncay Nas, (Gazi Üniversitesi, Kadın Hastalıkları ve Doğum Anabilim Dalı, Ankara, Türkiye)

İsmail Güler (Gazi Üniversitesi, Kadın Hastalıkları ve Doğum Anabilim Dalı, Ankara, Türkiye)

GORM:Gynecology Obstetrics & Reproductive Medicine

2 1

Yıl: 2021 Cilt: 27 Sayı: 1 Sayfa Aralığı: 65 - 71 Metin Dili: İngilizce DOI: 10.21613/GORM.2019.1007 İndeks Tarihi: 20-06-2021

Frequency of the Causes of Postmenopausal Bleeding, Results of a Tertiary Referral Center in Turkey

Öz:

OBJECTIVE: In this study, we aimed to determine the frequency of etiologic factors that causes postmenopausal bleeding.STUDY DESIGN: For the purpose, a total number of 200 women with postmenopausal bleeding wereincluded in the study. Medical records regarding history, physical examination, and endometrium biopsyof these cases were retrospectively analyzed. The frequency of etiologic factors and relevancy of pathological results with demographic factors were determined.RESULTS: Most frequent histopathologic diagnosis of the women with postmenopausal bleeding wereestablished as endometrial atrophy, endometrial polyp, inadequate material, cancer, proliferative endometrium, endometrial hyperplasia, and other disorders respectively. Contrarily the previous studies,our study showed that estrogen replacement therapy was not a reason for postmenopausal bleeding.CONCLUSION: Although endometrial atrophy is the most frequent cause, postmenopausal bleedingshould promptly be evaluated since endometrial hyperplasia and cancer are frequently the underlyingcause. We found that premalignant and malignant lesions were related to the patients’ BMI (body massindex), duration of postmenopause, the presence of diabetes, determination of thick endometrium by ultrasonography.

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1. Gosden RG. Biology of menopause: the causes and consequences of ovarian ageing: Academic Pr; 1985. Comparative Biochemistry and Physiology Part A: Physiology. 1986;83(4):798.
2. Rodger F. Walker J. Critchley H. Investigating the woman with postmenopausal bleeding. Trends In UGSH. 2005;10:1-4.
3. Salman MC. Bozdag G. Dogan S. Yuce K. Role of postmenopausal bleeding pattern and women's age in the prediction of endometrial cancer. Aust N Z J Obstet Gynaecol. 2013;53(5):484-8. doi: 10.1111/ajo.12113.
4. Ceylan B. Ozerdogan N. Factors affecting age of onset of menopause and determination of quality of life in menopause. Turk J Obstet Gynecol. 2015;12(1):43-9.doi: 10.4274/tjod.79836.
5. Gold EB. The timing of the age at which natural menopause occurs. Obstet Gynecol Clin North Am. 2011;38(3):425-40. doi: 10.1016/j.ogc.2011.05.002.
6. Cho HJ. Lee ES. Lee JY. Hong SN. Ji YI. Kim HY. et al. Investigations for postmenopausal uterine bleeding: special considerations for endometrial volume. Arch Iran Med. 2013;16(11):665-70.
7. Epstein E. Ramirez A. Skoog L. Valentin L. Transvaginal sonography, saline contrast sonohysterography and hysteroscopy for the investigation of women with postmenopausal bleeding and endometrium >5 mm. Ultrasound Obstet Gynecol. 2001;18(2):157-62. doi: 10.1046/j.1469-0705.2001.00472.x.
8. Epstein E. Ramirez A. Skoog L, Valentin L. Dilatation and curettage fails to detect most focal lesions in the uterine cavity in women with postmenopausal bleeding. Acta Obstet Gynecol Scand. 2001;80(12):1131-6. doi: 10.1034/j.1600-0412.2001.801210.x.
9. Oriel KA. Schrager S. Abnormal uterine bleeding. Am Fam Physician. 1999;60(5):1371-80; discussion 1381-2.
10. Astrup K, Olivarius Nde F. Frequency of spontaneously occurring postmenopausal bleeding in the general population. Acta Obstet Gynecol Scand. 2004;83(2):203-7.
11. van Doorn HC. Opmeer BC. Jitze Duk M. Kruitwagen RF, Dijkhuizen FP, Mol BW. The relation between age, time since menopause, and endometrial cancer in women with postmenopausal bleeding. Int J Gynecol Cancer. 2007;17(5):1118-23. doi:10.1111/j.1525-1438.2007. 00925.x.
12. Otify M. Fuller J. Ross J. Shaikh H. Johns J. Endometrial pathology in the postmenopausal woman-an evidence based approach to management. Obstet Gynaecol. 2015; 17(1):29-38. do i:10.1111/tog.12150.
13. Guido R. Kanbour-Shakir A. Rulin MC. Christopherson WA. Pipelle endometrial sampling. Sensitivity in the detection of endometrial cancer. J Reprod Med. 1995;40 (8):553-5.
14. Elkholi DGE. Nagy HM. Unexplained postmenopausal uterine bleeding from atrophic endometrium: Histopathological and hormonal studies. Middle East Fertil Soc J. 2015;20(4):262-70.
15. Sheng J. Chen Y. Pan J. Combining transvaginal sonography and endometrial cytology in the diagnosis of endometrial disorders in postmenopausal women. Zhonghua Fu Chan Ke Za Zhi. 2001;36(6):341-3.
16. Cravello L. Stolla V. Bretelle F. Roger V. Blanc B. Hysteroscopic resection of endometrial polyps: a study of 195 cases. Eur J Obstet Gynecol Reprod Biol. 2000; 93(2):131-4. doi: 10.1016/s0301-2115(00)00281-5. 17. Reslova T. Tosner J. Resl M. Kugler R. Vavrova I. Endometrial polyps. A clinical study of 245 cases. Arch Gynecol Obstet. 1998;262(3-4):133-9. doi: 10.1007/ s004040050241.
18. Linkov F. Edwards R. Balk J. Yurkovetsky Z. Stadterman B. Lokshin A. et al. Endometrial hyperplasia, endometrial cancer and prevention: gaps in existing research of modifiable risk factors. Eur J Cancer. 2008;44(12):1632-44. doi: 10.1016/j.ejca.2008.05.001.
19. Dimitraki M. Tsikouras P. Bouchlariotou S. Dafopoulos A. Liberis V. Maroulis G. et al. Clinical evaluation of women with PMB. Is it always necessary an endometrial biopsy to be performed? A review of the literature. Arch Gynecol Obstet. 2011;283(2):261-6. doi: 10.1007/s00404- 010-1601-3.
20. Fistonic I. Hodek B. Klaric P. Jokanovic L. Grubisic G. Ivicevic‐Bakulic T. Transvaginal sonographic assessment of premalignant and malignant changes in the endometrium in postmenopausal bleeding. J Clin Ultrasound. 1997;25(8):431-5. doi: 10.1002/(sici)1097- 0096(199710)25:8<431::aid-jcu4>3.0.co;2-k.
21. Phillip H. Dacosta V. Fletcher H. Kulkarni S. Reid M. Correlation between transvaginal ultrasound measured endometrial thickness and histopathological findings in Afro-Caribbean Jamaican women with postmenopausal bleeding. J Obstet Gynaecol. 2004;24(5):568-72. doi: 10.1080/01443610410001722671.
22. Karim R. Mack WJ. Hodis HN. Roy S. Stanczyk FZ. Influence of age and obesity on serum estradiol, estrone, and sex hormone binding globulin concentrations following oral estrogen administration in postmenopausal women. J Clin Endocrinol Metab. 2009;94(11):4136-43. doi: 10.1210/jc.2009-0643.
23. Shaw E. Farris M. McNeil J. Friedenreich C. Obesity and Endometrial Cancer. Recent Results Cancer Res. 2016;208:107-36. doi: 10.1210/jc.2009-0643.
24. Bruchim I. Biron‐Shental T. Altaras MM. Fishman A. Beyth Y. Tepper R. et al. Combination of endometrial thickness and time since menopause in predicting endometrial cancer in women with postmenopausal bleeding. J Clin Ultrasound.2004;32(5):219-24. doi: 10.1002/ jcu.20020.
25. Karasu AFG. Ates S. Gurbuz T. Sahin N. Takmaz T. Aydin S. A Clinico-pathological Study of Transvaginal Endometrial Thickness Measurement in Asymptomatic Postmenopausal Patients and Patients with Postmenopausal Bleeding. Gynecol Obstet Reprod Med. 2019:25(2):85-8. doi: https://doi.org/10.21613/GORM. 2018.851
26. Karlsson B. Granberg S. Wikland M. Ylöstalo P. Torvid K. Marsal K. et al. Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding-a Nordic multicenter study. Am J Obstet Gynecol. 1995; 172(5):1488-94. doi: 10.1016/0002-9378(95)90483-2.
27. Weber AM. Belinson JL. Piedmonte MR. Risk factors for endometrial hyperplasia and cancer among women with abnormal bleeding. Obstet Gynecol. 1999;93(4):594-8. doi: 10.1016/s0029-7844(98)00469-4.
28. Strinić T. Buković D. Bilonić I. Hirš I. Despot A. Boćan A. Socio-demographic characteristics of women with endometrial carcinoma. Coll Antropol. 2003;27 Suppl 1:55-9.
29. Weiderpass E. Persson I. Adami HO. Magnusson C. Lindgren A. Baron JA. Body size in different periods of life, diabetes mellitus, hypertension, and risk of postmenopausal endometrial cancer (Sweden). Cancer Causes Control. 2000;11(2):185-92. doi:10.1023/a:100894682 5313.
30. Parazzini F. La Vecchia C. Negri E. Luca Riboldi GL. Surace M. Benzi G. et al. Diabetes and endometrial cancer: An Italian case‐control study. Int J Cancer. 1999;81(4):539-42. doi:10.1002/(sici)1097-0215(1999 0517) 81:4<539::aid-ijc6>3.0.co;2-q.
31. Anderson KE. Anderson E. Mink PJ. Hong CP. Kushi LH. Sellers TA. et al. Diabetes and endometrial cancer in the Iowa women’s health study. Cancer Epidemiol Biomarkers Prev. 2001;10(6):611-6.
32. Gerber J. Sozański L. Suchocki S. The risk factors of endometrial cancer. Ginekol Pol. 2001;72(12A):1418-22.
33. Luo J. Beresford S. Chen C. Chlebowski R. Garcia L. Kuller L. et al. Association between diabetes, diabetes treatment and risk of developing endometrial cancer. Br J Cancer. 2014;111(7):1432-9. doi: 10.1038/bjc.2014.407.
34. Felix AS. Gaudet MM. La Vecchia CL. Nagle CM. Shu XO. Weiderpass E. et al. Intrauterine devices and endometrial cancer risk: a pooled analysis of the Epidemiology of Endometrial Cancer Consortium. Int J Cancer. 2015;136(5):E410-22. doi: 10.1002/ijc.29229.
35. Benshushan A. Paltiel O. Rojansky N. Brzezinski A. Laufer N. IUD use and the risk of endometrial cancer. Eur J Obstet Gynecol Reprod Biol. 2002;105(2):166-9. doi: 10.1016/s0301-2115(02)00153-7.
36. Cauley JA. Cummings SR. Black DM. Mascioli SR. Seeley DG. Prevalence and determinants of estrogen replacement therapy in elderly women. Am J Obstet Gynecol. 1990;163(5 Pt 1):1438-44. doi: 10.1016/0002- 9378(90)90602-4.
37. Wildemeersch D. Safety and comfort of long-term continuous combined transdermal estrogen and intrauterine levonorgestrel administration for postmenopausal hormone substitution–a review. Gynecol Endocrinol. 2016:32(8): 598-601. doi: 10.1080/09513590.2016.1177014.
38. Gray S. Breast cancer and hormone-replacement therapy: the Million Women Study. Lancet. 2003;362(9392):1332; author reply 1332. doi: 10.1016/S0140-6736(03)14598-9.
39. Stevenson JC. Establishing the risk related to hormone replacement therapy and cardiovascular disease in women. Suicide. 2019;14:20.

APA	sert U, Nas T, Guler I (2021). Frequency of the Causes of Postmenopausal Bleeding, Results of a Tertiary Referral Center in Turkey. , 65 - 71. 10.21613/GORM.2019.1007
Chicago	sert Umit yasemin,Nas Tuncay,Guler Ismail Frequency of the Causes of Postmenopausal Bleeding, Results of a Tertiary Referral Center in Turkey. (2021): 65 - 71. 10.21613/GORM.2019.1007
MLA	sert Umit yasemin,Nas Tuncay,Guler Ismail Frequency of the Causes of Postmenopausal Bleeding, Results of a Tertiary Referral Center in Turkey. , 2021, ss.65 - 71. 10.21613/GORM.2019.1007
AMA	sert U,Nas T,Guler I Frequency of the Causes of Postmenopausal Bleeding, Results of a Tertiary Referral Center in Turkey. . 2021; 65 - 71. 10.21613/GORM.2019.1007
Vancouver	sert U,Nas T,Guler I Frequency of the Causes of Postmenopausal Bleeding, Results of a Tertiary Referral Center in Turkey. . 2021; 65 - 71. 10.21613/GORM.2019.1007
IEEE	sert U,Nas T,Guler I "Frequency of the Causes of Postmenopausal Bleeding, Results of a Tertiary Referral Center in Turkey." , ss.65 - 71, 2021. 10.21613/GORM.2019.1007
ISNAD	sert, Umit yasemin vd. "Frequency of the Causes of Postmenopausal Bleeding, Results of a Tertiary Referral Center in Turkey". (2021), 65-71. https://doi.org/10.21613/GORM.2019.1007

APA	sert U, Nas T, Guler I (2021). Frequency of the Causes of Postmenopausal Bleeding, Results of a Tertiary Referral Center in Turkey. GORM:Gynecology Obstetrics & Reproductive Medicine, 27(1), 65 - 71. 10.21613/GORM.2019.1007
Chicago	sert Umit yasemin,Nas Tuncay,Guler Ismail Frequency of the Causes of Postmenopausal Bleeding, Results of a Tertiary Referral Center in Turkey. GORM:Gynecology Obstetrics & Reproductive Medicine 27, no.1 (2021): 65 - 71. 10.21613/GORM.2019.1007
MLA	sert Umit yasemin,Nas Tuncay,Guler Ismail Frequency of the Causes of Postmenopausal Bleeding, Results of a Tertiary Referral Center in Turkey. GORM:Gynecology Obstetrics & Reproductive Medicine, vol.27, no.1, 2021, ss.65 - 71. 10.21613/GORM.2019.1007
AMA	sert U,Nas T,Guler I Frequency of the Causes of Postmenopausal Bleeding, Results of a Tertiary Referral Center in Turkey. GORM:Gynecology Obstetrics & Reproductive Medicine. 2021; 27(1): 65 - 71. 10.21613/GORM.2019.1007
Vancouver	sert U,Nas T,Guler I Frequency of the Causes of Postmenopausal Bleeding, Results of a Tertiary Referral Center in Turkey. GORM:Gynecology Obstetrics & Reproductive Medicine. 2021; 27(1): 65 - 71. 10.21613/GORM.2019.1007
IEEE	sert U,Nas T,Guler I "Frequency of the Causes of Postmenopausal Bleeding, Results of a Tertiary Referral Center in Turkey." GORM:Gynecology Obstetrics & Reproductive Medicine, 27, ss.65 - 71, 2021. 10.21613/GORM.2019.1007
ISNAD	sert, Umit yasemin vd. "Frequency of the Causes of Postmenopausal Bleeding, Results of a Tertiary Referral Center in Turkey". GORM:Gynecology Obstetrics & Reproductive Medicine 27/1 (2021), 65-71. https://doi.org/10.21613/GORM.2019.1007