Objective: To investigate endometrial histopathology in a geographically defined population of women presenting with postmenopausal bleeding.
Design: Prospective study with collection of data during an 18-month period.
Setting: The health care county of Skaraborg, Sweden.
Subjects: Dilatation and curettage using general anaesthesia was performed on 457 postmenopausal women suffering from uterine bleeding. Women using hormone replacement therapy for climacteric complaints were not included in the investigation.
Main outcome measures: The frequency of bleeding was correlated to endometrial histopathology, and in relevant cases to pathological conditions in cervix and ovaries in a defined population of postmenopausal women.
Results: The incidence of postmenopausal bleeding decreased with increasing age while the probability of cancer as the underlying cause increased. The peak incidence of endometrial carcinoma was found in women between 65 and 69 years of age. Endometrial histopathology showed: atrophy (50%); proliferation (4%); secretion (1%); polyps (9%); different degrees of hyperplasia (10%); adenocarcinoma (8%); not representative (14%); other disorders (3%). In six women a squamous carcinoma of the cervix was found, and eight proved to have ovarian tumours.
Conclusions: The histopathological finding of endometrial adenomatous hyperplasia or cancer in about 15% of the postmenopausal women with bleeding justifies a thorough examination. The probability of cancer as the underlying cause increased with age. The endometrium was atrophic in 50%. Eight women had ovarian tumours. These findings may imply that transvaginal ultrasound examination should be included in the evaluation of postmenopausal bleeding as occasionally endometrial biopsies of atrophic endometrium could be avoided and ovarian pathology detected.