Menopause: Is there a need to investigate vaginal bleeding after the menopause?
Acta Obstet Gynecol Scand. 2008;87(1):89-93.
What is the recurrence rate of postmenopausal
bleeding in women who have a thin endometrium
during a first episode of postmenopausal
bleeding?
Van Doorn HC, Timmermans A, Opmeer BC,
Kruitwagen RF, Dijkhuizen FP, Kooi GS, Van De
Weijer PH, Mol BW, Dupomeb F.
Department of Obstetrics and Gynecology, Erasmus
Medical Center, Rotterdam, The Netherlands.
Objectives:
To determine the incidence and
significance of recurrent postmenopausal
bleeding among women diagnosed with an
endometrial thickness < or =4 mm after a first
episode of postmenopausal bleeding.
Methods:
Consecutive patients not using hormone
replacement therapy (HRT) presenting with a
first episode of postmenopausal bleeding and an
endometrial thickness < or =4 mm at transvaginal
ultrasonography (TVU) were managed expectantly.
In case of recurrent bleeding, the patient was
evaluated according to the hospital's local
policy with TVU, office endometrial sampling,
hysteroscopy or dilatation and curettage (DandC)
or a combination of these tests. We evaluated
the incidence of recurrent bleeding, potential
risk factors for recurrent bleeding, and the
diagnosis made after recurrent bleeding.
Results:
A total of 607 patients were registered
with a first episode of postmenopausal bleeding,
of whom 249 had an endometrial thickness < or =4
mm. Follow-up took place with a median of 174
weeks (range: 4-250 weeks). During follow-up, 25
of the 249 patients (10%; 95% CI: 6.6-14%) had
recurrent bleeding. Median time until recurrence
of bleeding was 49 weeks (range: 9-186 weeks).
Two patients with recurrent bleeding turned out
to have an endometrial carcinoma (8%; 95% CI:
2.2-25%), and 1 patient had a malignant
melanoma. Time since menopause, age, body mass
index, hypertension, diabetes and anticoagulants
were not predictive for recurrent bleeding.
Conclusion:
The recurrence rate after a first
episode of postmenopausal bleeding managed
expectantly is low and cannot be predicted by
patient characteristics. Patients with recurrent
bleeding should be re-evaluated, as they bear a
considerable risk of carcinoma.
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