Postmenopausal bleeding: correlation between pathology findings, endometrial thickness, and risk factors for endometrial cancer
- Obstetrics & Gynecology International Journal
-
Bianchi F,<sup>1,2</sup> Mantero J,<sup>1</sup> De León M,<sup>1</sup> Delgado B,<sup>1</sup> Giudice JB,<sup>2</sup> Jalil L,1 Quiroga F,<sup>1,2</sup> Boixart A,<sup>1,2 </sup>Apartin L,<sup>1</sup> Codoni MJ,<sup>2</sup> Camargo A<sup>2</sup>
PDF Full Text
Abstract
Objectives: To analyze the correlation between pathological findings and risk factors for endometrial disease in patients with postmenopausal bleeding (PMB), assessing the presence of endometrial cancer and its relationship with specific clinical characteristics.
To determine the usefulness of transvaginal ultrasound in predicting malignancy and its agreement with histological findings.
Materials and methods: This is an observational, retrospective, descriptive study conducted between January 2017 and February 2025.
Postmenopausal patients with PMB who underwent hysteroscopy (HSC) were included. The variables analyzed were age, body mass index (BMI), hypertension (HTN), diabetes (DM), tamoxifen use, endometrial thickness (ET) assessed by transvaginal ultrasound, and the histopathology findings of the collected samples. A database was created for statistical analysis.
Results: A total of 548 postmenopausal patients with PMB were analyzed; all were evaluated with transvaginal ultrasound and hysteroscopy.
The median BMI was 29 kg/m² (n=506 with available data); 48.0% of patients were obese (n=243). Hypertension was the most prevalent risk factor (44.0%, n= 241), followed by diabetes mellitus (14.1%, n= 77) and tamoxifen use (8.8%, n= 48).
An endometrial thickness ≥10 mm was the most common ultrasound finding (49.8%, n=273). The most frequent diagnosis was endometrial polyp (43.6%, n=239), followed by endometrial atrophy (19.0%, n=104).
Endometrial cancer was diagnosed in 16.4% of patients (n=90). Among patients diagnosed with cancer, 74.4% had an endometrial thickness ≥10 mm, 20.0% between 5–10 mm, and 4.4% ≤5 mm; in one patient, endometrial thickness could not be assessed.
Older age and an endometrial thickness ≥10 mm were the only factors independently associated with endometrial cancer in multivariate analysis (OR 1.09 per year and OR 3.71, respectively; p < 0.001). Although hypertension was associated with cancer in the univariate analysis (p = 0.006), this association did not remain significant after adjusting for age and endometrial thickness
Conclusion: Postmenopausal bleeding represents a key clinical sign for the suspicion and early detection of endometrial cancer. In our study, older age and an endometrial thickness ≥10 mm were the strongest independent predictors of endometrial cancer. While clinical risk factors such as hypertension and obesity were associated with malignancy in univariate analysis, these associations were attenuated after adjustment for age and endometrial thickness.
These findings underscore the importance of integrating clinical, ultrasonographic, and histopathological variables to optimize the diagnostic and therapeutic approach in postmenopausal women.
To determine the usefulness of transvaginal ultrasound in predicting malignancy and its agreement with histological findings.
Materials and methods: This is an observational, retrospective, descriptive study conducted between January 2017 and February 2025.
Postmenopausal patients with PMB who underwent hysteroscopy (HSC) were included. The variables analyzed were age, body mass index (BMI), hypertension (HTN), diabetes (DM), tamoxifen use, endometrial thickness (ET) assessed by transvaginal ultrasound, and the histopathology findings of the collected samples. A database was created for statistical analysis.
Results: A total of 548 postmenopausal patients with PMB were analyzed; all were evaluated with transvaginal ultrasound and hysteroscopy.
The median BMI was 29 kg/m² (n=506 with available data); 48.0% of patients were obese (n=243). Hypertension was the most prevalent risk factor (44.0%, n= 241), followed by diabetes mellitus (14.1%, n= 77) and tamoxifen use (8.8%, n= 48).
An endometrial thickness ≥10 mm was the most common ultrasound finding (49.8%, n=273). The most frequent diagnosis was endometrial polyp (43.6%, n=239), followed by endometrial atrophy (19.0%, n=104).
Endometrial cancer was diagnosed in 16.4% of patients (n=90). Among patients diagnosed with cancer, 74.4% had an endometrial thickness ≥10 mm, 20.0% between 5–10 mm, and 4.4% ≤5 mm; in one patient, endometrial thickness could not be assessed.
Older age and an endometrial thickness ≥10 mm were the only factors independently associated with endometrial cancer in multivariate analysis (OR 1.09 per year and OR 3.71, respectively; p < 0.001). Although hypertension was associated with cancer in the univariate analysis (p = 0.006), this association did not remain significant after adjusting for age and endometrial thickness
Conclusion: Postmenopausal bleeding represents a key clinical sign for the suspicion and early detection of endometrial cancer. In our study, older age and an endometrial thickness ≥10 mm were the strongest independent predictors of endometrial cancer. While clinical risk factors such as hypertension and obesity were associated with malignancy in univariate analysis, these associations were attenuated after adjustment for age and endometrial thickness.
These findings underscore the importance of integrating clinical, ultrasonographic, and histopathological variables to optimize the diagnostic and therapeutic approach in postmenopausal women.
Keywords
postmenopausal bleeding, endometrial cancer, transvaginal ultrasound, hypertension, obesity, diabetes, hormone replacement therapy, endometrial thickness
