Types and Outcomes of Diagnostic Measures provided for women Presented with Postmenopausal Bleeding
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Abstract
Background: Postmenopausal bleeding (PMB) is bleeding from the genital tract after 12 months of amenorrhea in a woman over the age of 50, or 24 months if below the age of 50 years, in 10% of women presented with PMB, the cause is endometrial cancer.
Purpose: To assess the clinical presentation types and outcomes of diagnostic measures provided for women presenting with PMB at Saad Abu-Alela Hospital, Khartoum, Sudan.
Methodology: It was a descriptive, cross-sectional study conducted at Saad Abu-Alela Teaching Hospital in the period from January to December 2022.
An interview questionnaire was used for data collection. Fifty-nine (59) postmenopausal women were included in this study, age, parity, risk factors, duration of bleeding, duration of menopause, ultrasound findings, and hysteroscopy findings were recorded.
Results: The majority of study participants were aged between 50-54 years, menopause duration was most 1-4 years, most of the participants were educated and medically free, DM and HTN, and most of the participants were multiparous. Duration of PMB ranged between weeks in a third of cases and up to more than a year in some cases, amount of bleeding was mild in more than half. Ultrasound is used to assess the endometrial thickness and other findings, also hysteroscopy and biopsy or Dilation and curettage and hysterectomy.
Conclusion: The ultrasound and endometrial biopsy via inpatient hysteroscopy and dilatation and curettage were the best tools for evaluation of (PMB), benign conditions were the most frequent outcome and endometrial cancer.
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Copyright (c) 2025 Elsammani M, et al.
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Astrup K, Olivarius NDF. Frequency of spontaneously occurring postmenopausal bleeding in the general population. Acta Obstet Gynecol Scand. 2004;83(2):203-207. Available from: https://doi.org/10.1111/j.0001-6349.2004.00400.x
Timmermans A, Gerritse MB, Opmeer BC, Jansen FW, Mol BW, Veersema S. Diagnostic accuracy of endometrial thickness to exclude polyps in women with postmenopausal bleeding. J Clin Ultrasound. 2008;36(5):286-290. Available from: https://doi.org/10.1002/jcu.20415
Buchanan C, Robinson M, Macdonald MC. Endometrial cancer rate in Hormone replacement therapy users with postmenopausal bleeding: Retrospective cohort study. Post Reprod Health. 2022;28(3):143–8. Available from: https://doi.org/10.1177/20533691221116171
Xue H, Shen WJ, Zhang Y. The pathological pattern of endometrial abnormalities in postmenopausal women with bleeding or thickened endometrium. World J Clin Cases. 2022;10(7):2159–65. Available from: https://doi.org/10.12998/wjcc.v10.i7.2159
Jones ER. Developing Tests for Endometrial Cancer Detection (DETECT) [dissertation]. Manchester (UK): The University of Manchester; 2023. Available from: https://research.manchester.ac.uk/en/studentTheses/developing-tests-for-endometrial-cancer-detection-detect
Saccardi C, Spagnol G, Bonaldo G, Marchetti M, Tozzi R, Noventa M. New light on endometrial thickness as a risk factor of cancer: what do clinicians need to know? Cancer Manag Res. 2022;13:1331–40. Available from: https://doi.org/10.2147/cmar.s294074
Teasdale A, Gale K, Holloway D. Menstrual and hormonal dysfunction. In: Nursing Management of Women’s Health: A Guide for Nurse Specialists and Practitioners. 2019;7-47.
Swetha RN, Rao MP, Penumaka R. Evaluation of Endometrial Thickness by Transvaginal Sonography in Postmenopausal Women with Bleeding: A Cross-sectional Study. J Clin Diagn Res. 2024;18(1):QC12–7. Available from: https://doi.org/10.7860/JCDR/2024/67553.18975
Amer ASS, Diab YMS, Fotouh AMMAE. Comparison Between Endometrial Thickness by TVS And Endometrial Histopathology in Postmenopausal Women. Al-Azhar Int Med J. 2024;5(3):48. Available from: https://aimj.researchcommons.org/cgi/viewcontent.cgi?article=2335&context=journal
Stephenson RG, Cathcart DB. The Physical Therapist’s Guide to Women's Pelvic, Perinatal, and Reproductive Health. New York: Routledge; 2025. Available from: https://www.routledge.com/The-Physical-Therapists-Guide-to-Womens-Pelvic-Perinatal-and-Reproductive-Health/Stephenson-Cathcart/p/book/9781630917869?srsltid=AfmBOoq4rvJwau1sSYgwA4qQ-9pNQf4mWlLKGgeM4Iom3Kf1-YxPYcDc
Baker-Rand H, Kitson SJ. Recent advances in endometrial cancer prevention, early diagnosis, and treatment. Cancers. 2024;16(5):1028. Available from: https://doi.org/10.3390/cancers16051028
Doll KM, Pike M, Alson J, Williams P, Carey E, Stürmer T, et al. Endometrial thickness as diagnostic triage for endometrial cancer among Black individuals. JAMA Oncol. 2024;10(8):1068–76. Available from: https://doi.org/10.1001/jamaoncol.2024.1891
Cabrera S, de la Calle I, Baulies S, Gil-Moreno A, Colas E. Screening strategies to improve early diagnosis of endometrial cancer. J Clin Med. 2024;13(18):5445. Available from: https://doi.org/10.3390/jcm13185445
Vitale SG, Buzzaccarini G, Riemma G, Pacheco LA, Sardo ADS, Carugno J, et al. Endometrial biopsy: Indications, techniques, and recommendations. An evidence-based guideline for clinical practice. J Gynecol Obstet Hum Reprod. 2023;52(6):102588. Available from: https://doi.org/10.1016/j.jogoh.2023.102588
De Silva PM. The diagnosis and treatment of endometrial pathology in the outpatient setting [dissertation]. Birmingham (UK): University of Birmingham; 2023.
Sutedja MN, Cristobal RJGV, Ferraris MCCC, Alcaraz CJL, Gonzales-Acantilado GV. The Comparative Efficacy of Endometrial Biopsy using Pipelle and Diagnostic Dilatation & Curettage in Mariano Marcos Memorial Hospital and Medical Center. Bioscientia Med. 2023;7(10):3652–7. Available from: https://doi.org/10.37275/bsm.v7i10.871
Demirkiran F, Yavuz E, Erenel H, Bese T, Arvas M, Sanioglu C. Which is the best technique for endometrial sampling? Aspiration (pipelle) versus dilatation and curettage (D&C). Arch Gynecol Obstet. 2012;286:1277–88. Available from: https://doi.org/10.1007/s00404-012-2438-8
Abo El-fath A, Alnemr A, Eid E, Harb OA. Diagnostic Value of Pipelle, Curretage Biopsy and Hysteroscopic Biopsy in Cases of Postmenopausal Bleeding. Zagazig Univ Med J. 2024;30(1.7):4019–32. Available from: http://dx.doi.org/10.21608/zumj.2024.264675.3129
Waris A, Bibi T, Ch S, Wajid A, Jaweria F, Munir MW. Comparison of diagnostic accuracy of endometrial sampling techniques; D&C and Pipelle sampling in patients of endometrial hyperplasia. Res Med Sci Rev. 2025;3(1):976–87. Available from: https://thermsr.com/index.php/Journal/article/view/472
Gupta A. Clinical and histopathological characteristics in women with Postmenopausal bleeding. Age (years). 45(49):10.
Purushotham MK. Clinicopathological Study of Postmenopausal Bleeding [Master's thesis]. Bangalore: Rajiv Gandhi University of Health Sciences (India); 2018.
Jajou R, van Puijenbroek EP, Veldkamp R, Overbeek JA, van Hunsel FP, Kant AC. General practitioner consultation for postmenopausal bleeding after COVID‐19 vaccination—a self‐controlled cohort study. Br J Clin Pharmacol. 2025. Available from: https://doi.org/10.1002/bcp.70045
Ewies AA, Musonda P. Managing postmenopausal bleeding revisited: what is the best first line investigation and who should be seen within 2 weeks? A cross-sectional study of 326 women. Eur J Obstet Gynecol Reprod Biol. 2010;153(1):67–71. Available from: https://doi.org/10.1016/j.ejogrb.2010.06.009
Khalid MM. Endocrine identification of menopausal status of Sudanese women [Internet]. 2010 [cited 2025 Apr 18]. Available from: https://inis.iaea.org/records/16frp-vsh57
Nasreen SZA, Mahjabeen N, Shahreen S. Postmenopausal bleeding: An update. Eur J Med Health Sci [Internet]. 2021;3(1):28–33. Available from: https://ej-med.org/index.php/ejmed/article/view/652
Bukhari NA, Qazi WA, Jahan S, Asmat S, Akhter N, Jabeen R. Risk factors associated with postmenopausal bleeding and endometrial carcinoma. Prof Med J [Internet]. 2021;28(2):208–13. Available from: https://doi.org/10.29309/TPMJ/2021.28.02.3447
Ramezanali F, Khalili G, Arabipoor A, Lankarani NB, Moini A. Relationships between serum luteinizing hormone level, endometrial thickness and body mass index in polycystic ovary syndrome patients with and without endometrial hyperplasia. Int J Fertil Steril [Internet]. 2016;10(1):36–41. Available from: https://doi.org/10.22074/ijfs.2016.4766
Okman-Kilic T, Kucuk M. The effects of antihypertensive agents on endometrial thickness in asymptomatic, hypertensive, postmenopausal women. Menopause [Internet]. 2003;10(4):362–5. Available from: https://doi.org/10.1097/01.gme.0000051508.69832.ba
Bornstein J, Auslender R, Goldstein S, Kohan R, Stolar Z, Abramovici H. Increased endometrial thickness in women with hypertension. Am J Obstet Gynecol [Internet]. 2000;183(3):583–7. Available from: https://doi.org/10.1067/mob.2000.106719
Fatima SS, Naib JM, Sharafat Z, Mazhar T. Postmenopausal bleeding-an alarming symptom of endometrial carcinoma. J Med Sci. 2014;22(4):166–70. Available from: https://jmedsci.com/index.php/Jmedsci/article/view/249
Wang L, Quan S, Bai E, Yang X. Analysis of clinical data of different endometrial pathological types in perimenopausal women with abnormal uterine bleeding. Front Oncol. 2024;14:1370681. Available from: https://doi.org/10.3389/fonc.2024.1370681
Gök S, Atigan A, Gök BC. A new method that facilitates the diagnosis of endometrial cancer: is the ratio of endometrial thickness to the full thickness of the uterine wall and subcutaneous adipose tissue measurements. Menopause Rev. 2024;23(1):25–30. Available from: https://doi.org/10.5114/pm.2024.136961
Ahmed AAM, Mohamed BEE, Abdel Moneim OAA. Comparative Study between the Diagnostic Accuracy of 3D Ultrasound and Hysteroscopy in Patient with Post Menposal Uterine Bleeding. Al-Azhar Int Med J. 2024;5(4):52. Available from: https://aimj.researchcommons.org/journal/vol5/iss4/52/
Al-Kamil R. Clinical effectiveness of hysteroscopy in abnormal uterine bleeding. J Obstet Gynaecol. 2001;21(6):614-6. Available from: https://doi.org/10.1080/01443610120085609
Pacheco JC, Kempers RD. Etiology of postmenopausal bleeding. Obstet Gynecol. 1968;32(1):40-46. Available from: https://pubmed.ncbi.nlm.nih.gov/5742088/
Bettocchi S, Ceci O, Nappi L, Di Venere R, Masciopinto V, Pansini V, et al. Operative office hysteroscopy without anesthesia: analysis of 4863 cases performed with mechanical instruments. J Am Assoc Gynecol Laparosc. 2004;11(1):59–61. Available from: https://doi.org/10.1016/s1074-3804(05)60012-6
Begum J, Samal R. A clinicopathological evaluation of postmenopausal bleeding and its correlation with risk factors for developing endometrial hyperplasia and cancer: a hospital-based prospective study. J Midlife Health. 2019;10(4):179–83. Available from: https://doi.org/10.4103/jmh.jmh_136_18
Ghoubara A, Price MJ, Fahmy MSED, Ait-Allah AS, Ewies A. Prevalence of hyperplasia and cancer in endometrial polyps in women with postmenopausal bleeding: A systematic review and meta-analysis. Post Reprod Health. 2019;25(2):86–94. Available from: https://doi.org/10.1177/2053369119833583
Tian Y, Bai B, Wang L, Zhou Z, Tang J. Contributing factors related to abnormal uterine bleeding in perimenopausal women: a case-control study. J Health Popul Nutr. 2024;43(1):52. Available from: https://jhpn.biomedcentral.com/articles/10.1186/s41043-024-00540-4
Tahseen H, Khokhar S, Atif N, Qurban S, Khurshid HN, Maqsud M. Histopathological Diagnosis of Hysterectomy Specimens in Abnormal Uterine Bleeding. Pak J Med Health Sci. 2023;17(04):232. Available from: https://doi.org/10.53350/pjmhs2023174232