POSTMENOPAUSAL BLEEDING

Objective : To evaluate the etiology, incidence of malignancy and interval between menopause and onset of abnormal vaginal bleeding inpostmenopausal 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: Adetailed history was taken followed by a detailed general physical, abdominal, pelvic and per-rectal examination. Cervical pap smear was donein all the patients except those with obvious cervical growth. Besides routine laboratory work, abdominal ultrasonography was done in all thecases. All patients were invariably subjected to fractional curretage and cervical biopsy was taken where indicated. Results: Malignancy wasfound 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 hyperplasiain 5.71%, carcinoma of ovary in 2.85%, liomyosarcoma in 2.85%, senile vaginitis, trauma, and forgotten IUCD each in 2.85% of cases. Etiologyremained undetermined in 5.71 % cases. Malignancy was directly related to years of clear span and was 88.88% in cases presenting 10 yearsor more after the menopause. Conclusion: Carcinoma of cervix was the commonest cause of postmenopausal bleeding in our study. Screeningprogramme for early detection of carcinoma of cervix at a pre-invasive stage is highly recommended.