Risk factors associated with postmenopausal bleeding and endometrial carcinoma.

Abstract

Objective: The objectives of the study were to identify the common causes of post menopausal bleeding, benign and malignant causes of post menopausal bleeding and also the identification of risk factors for endometrial carcinoma in women with postmenopausal bleeding. Study Design: Cross sectional survey. Setting: Fauji Foundation Hospital Rawalpindi. Period: August 2018 to January 2019. Material & Methods: A total of 224 women with post menopausal bleeding were included in this study. Data was collected through the self structured questionnaire in which we have included patient’s demographics, risk factors of Post menopausal bleeding and risk factors of endometrial carcinoma. Histopathological investigations of endometrial sampling were done for identification of benign and malignant causes of post menopausal bleeding. Results: Mean age of the women was 59.17 years and mean parity was found to be 2.24. Out of 224 patients 106(47.3%) women had their menopause in duration of 6 to 10 years while 75(33.9%) had menopause in time duration of first 5 years showing high frequency trend of post menopausal bleeding in first ten years duration after menopause. Out of 224 patients 30(13.4) were of normal weight, 94(42.0) were overweight while 100(44.6) were obese according to BMI criteria. Endometrial carcinoma was found in 40 women with post menopausal bleeding. Among them age at menarche was found to be 9 to 13 years in 27(67.5%) patients while more than 13 years in 13(32.5%) women.  Age at menopause was found more than 55 years in 20(50%) patients while less than 55 years also in 20(50%) patients. Personal history of breast carcinoma was reported in 6(15%) similarly family history was also found in 6(15%) women. Family history of CA endometrium was observed in 3(7.5%). History of PCOs was also observed in 5(12.5) patients. Menstrual irreguraity in perimenopausal period was found in 18(45%) patients with endometrial CA. Nulliparity was reported in 21(52.5%) patients. 12(30%) were on estrogen use while 4(10%) were on Tamoxifen use. Conclusion: Diabetes Mellitus and Hypertension were observed as common risk factors for post menopausal bleeding. Endometrial Carcinoma, cervix carcinoma and Hyperplasia with atypia were common malignant causes while endometrial polyp and fibroid uterus were commonly found benign causes of post menopausal bleeding. Early menarche, menopausal duration of more than one year, obesity and diabetes mellitus were common risk factors for endometrial carcinoma.