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Abstract
Objective
To determine the frequency and causes of postmenopausal bleeding (PMB) among women presenting to Gynecology Unit III, Dr. Ruth K. M. Pfau Civil Hospital, Karachi, Pakistan.
Methods
A cross-sectional descriptive study was conducted among 139 women presenting with PMB at Gynecology Unit III, Dr. Ruth K. M. Pfau Civil Hospital, Karachi. Participants were selected through non-probability consecutive sampling. Women aged more than 45 years presenting with PMB were included, while women receiving anticoagulant therapy, with a history of pelvic radiation, bladder cancer, uterovaginal prolapse with ulceration, or bleeding attributable to hemorrhoids were excluded. Demographic and clinical characteristics, including age, body mass index, parity, duration since menopause, diabetes mellitus, hypertension, smoking, family history of malignancy, hormonal therapy, and bleeding characteristics, were recorded. Transvaginal ultrasonography and histopathological findings were documented where applicable. Data were analyzed using SPSS version 23. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages.
Results
The mean age of participants was 57.8 ± 7.9 years, with a mean BMI of 27.1 ± 4.2 kg/m². Endometrial atrophy was the most common cause of PMB, identified in 46 (33.1%) women, followed by endometrial hyperplasia in 24 (17.3%) and endometrial polyp in 18 (12.9%). Endometrial carcinoma was diagnosed in 16 (11.5%), while cervical carcinoma was identified in 5 (3.6%) participants. Overall, malignant pathology was identified in 21 (15.1%) women. Malignant pathology was significantly associated with age (p=0.041), whereas associations with BMI (p=0.580) and duration since menopause (p=0.090) were not statistically significant.
Conclusion
Postmenopausal bleeding has a broad etiological spectrum, with endometrial atrophy being the most frequent cause. The identification of premalignant and malignant pathologies emphasizes the importance of appropriate and timely diagnostic evaluation, particularly among older women presenting with PMB.