POSTMENOPAUSAL BLEEDING

AN EXPERIENCE AT BAHAWAL VICTORIA HOSPITAL, BAHAWALPUR

Abstract

Objective : To evaluate the etiology, incidence of malignancy and interval between menopause and onset of abnormal vaginal bleeding in
postmenopausal women. Design: Prospective study. Place And Duration of Study: The study was conducted at Bahawal Victoria Hospital,
Bahawalpur for a period of 14 months (February 2002 to March 2003). Subjects: Thirty five cases of postmenopausal bleeding. Methods: A
detailed history was taken followed by a detailed general physical, abdominal, pelvic and per-rectal examination. Cervical pap smear was done
in all the patients except those with obvious cervical growth. Besides routine laboratory work, abdominal ultrasonography was done in all the
cases. All patients were invariably subjected to fractional curretage and cervical biopsy was taken where indicated. Results: Malignancy was
found to be the most common cause (51.42%) of postmenopausal bleeding. Carcinoma of the cervix was commonest and found in 34.28%,
carcinoma of endometrium in 11.42%, atrophic endometrium in 11.42%, polyps in 8.57%, chronic cervicitis in 8.57%, endometrial hyperplasia
in 5.71%, carcinoma of ovary in 2.85%, liomyosarcoma in 2.85%, senile vaginitis, trauma, and forgotten IUCD each in 2.85% of cases. Etiology
remained undetermined in 5.71 % cases. Malignancy was directly related to years of clear span and was 88.88% in cases presenting 10 years
or more after the menopause. Conclusion: Carcinoma of cervix was the commonest cause of postmenopausal bleeding in our study. Screening
programme for early detection of carcinoma of cervix at a pre-invasive stage is highly recommended.