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Veeranaraphanit U, Saeaib N, Srisintorn W. Predicting Endometrial Hyperplasia and Endometrial Cancer on Recurrent Abnormal Uterine Bleeding. Obstet Gynecol 2024; 144:259-265. [PMID: 38870531 DOI: 10.1097/aog.0000000000005641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/18/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE To develop predictive models for endometrial hyperplasia and endometrial cancer in patients with recurrent abnormal uterine bleeding (AUB). METHODS This retrospective cohort study analyzed patients with recurrent AUB who had previous endometrial sampling that showed benign results between January 2013 and December 2021. A model was constructed from the significant factors associated with endometrial hyperplasia and endometrial cancer using multivariate logistic regression. Risk scores were calculated from the log odds of each significant predictive factor and were subsequently subcategorized into risk groups. The overall performance and internal validation of the model were assessed with the area under the receiver operating characteristic curve (AUC) and bootstrap methods. RESULTS Of the total 456 patients with recurrent AUB, endometrial hyperplasia and endometrial cancer were detected in 8.3% and 2.2% of cases, respectively. The average interval between the first and second endometrial samplings was 25.1 months. Factors significantly associated with endometrial hyperplasia and endometrial cancer included age older than 45 years (odds ratio [OR] 2.86, 95% CI, 1.31-7.03), nulliparity (OR 3.50, 95% CI, 1.76-6.85), a history of endometrial polyp (OR 3.69, 95% CI, 1.93-7.05), and an interval of less than 12 months between sampling (OR 2.36, 95% CI, 1.25-4.42). Predictive factors were scored and categorized into three groups: 0-3, 5-8, and 9-11 points. The corresponding risks for endometrial hyperplasia and endometrial cancer in these groups were 4.7%, 15.5%, and 57.1%, respectively. The AUC was 73.1%, with a mean absolute error of 0.01. CONCLUSION Endometrial hyperplasia and endometrial cancer occur at low incidence among one-fifth of patients with AUB who experience recurrent bleeding. Older age, nulliparity, a history of endometrial polyps, and an interval of less than 12 months between samplings are predictive factors for endometrial hyperplasia and endometrial cancer in this cohort.
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Affiliation(s)
- Unyamanee Veeranaraphanit
- Department of Obstetrics and Gynecology and the Department of Family and Preventive Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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van Maldegem LDPR, van der Zande JA, van Werkhoven LA, Ewing‐Graham PC, Heemskerk‐Gerritsen BAM, van Doorn HC. Recurrent postmenopausal bleeding: Pathological findings and predictive factors. A multicenter, prospective, observational study. Acta Obstet Gynecol Scand 2024; 103:1283-1291. [PMID: 38695570 PMCID: PMC11168275 DOI: 10.1111/aogs.14851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Recurrent postmenopausal bleeding (PMB) occurs in 6%-25% of postmenopausal women who have experienced a previous episode of PMB. The question of whether recurrent PMB leads to a higher risk of endometrial cancer (EC) in comparison to a single episode of PMB is, however, controversial. Furthermore, little is known about predictive factors for recurrent PMB. MATERIAL AND METHODS A multicenter prospective cohort study was conducted over a 5-year period in four hospitals in the Netherlands. Women with PMB undergoing endometrial sampling and aged 40 years and older were included. Occurrence of recurrent PMB was retrospectively determined. Primary outcomes included (1) the incidence of recurrent PMB and (2) differences in pathological findings between patients with a single episode vs recurrent PMB. Secondary outcomes included (1) the association between diagnosis of benign polyps at first PMB and pathological findings at recurrent PMB and (2) factors predictive for recurrent PMB. RESULTS A total of 437 women with PMB were included, of whom 360 were at risk of recurrent PMB. With a median follow-up of 61 months (IQR (Interquartile range) 44-73), 26.4% experienced recurrent PMB. Patients with recurrent PMB were more often diagnosed with benign polyps (34.7% vs. 25.1%, p-value 0.015) and less frequently with a malignancy (5.3% vs. 17.8%, p-value 0.015), compared to patients with a single episode of PMB. Benign polyps at initial PMB were not associated with a (pre)malignancy at recurrence (OR 4.16, 95% CI 0.75-23.03). Predictive factors for recurrent PMB included use of hormone replacement therapy (HRT) (OR 3.32, 95% CI 1.64-6.72), and benign polyps at initial PMB (OR 1.80, 95% CI 1.07-3.04). CONCLUSIONS Recurrent PMB is common in women with a previous episode of PMB. Compared to patients with a single episode of PMB, patients with recurrent PMB and benign histological outcomes at accurate workup during their first episode were less often diagnosed with malignancies and more frequently with benign polyps. Benign polyps at first PMB are predictive for recurrent PMB, but not for a higher risk of (pre)malignancy.
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Affiliation(s)
- Laura D. P. R. van Maldegem
- Department of Gynecologic OncologyErasmus MC Cancer Institute, University Medical Center RotterdamRotterdamthe Netherlands
| | - Johanna A. van der Zande
- Department of Gynecologic OncologyErasmus MC Cancer Institute, University Medical Center RotterdamRotterdamthe Netherlands
| | - Lucy A. van Werkhoven
- Department of Gynecologic OncologyErasmus MC Cancer Institute, University Medical Center RotterdamRotterdamthe Netherlands
| | - Patricia C. Ewing‐Graham
- Department of PathologyErasmus MC Cancer Institute, University Medical Center RotterdamRotterdamthe Netherlands
| | | | - Helena C. van Doorn
- Department of Gynecologic OncologyErasmus MC Cancer Institute, University Medical Center RotterdamRotterdamthe Netherlands
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Talwar S, Kaur H, Tapasvi I, Nibhoria S, Tapasvi C. Clinical and Histopathological Characteristics in Women With Postmenopausal Bleeding: A Study of 120 Women in a Tertiary Care Hospital in Punjab. Cureus 2024; 16:e51690. [PMID: 38313886 PMCID: PMC10838394 DOI: 10.7759/cureus.51690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 02/06/2024] Open
Abstract
Background Postmenopausal bleeding (PMB) is defined as blood loss from the genital tract occurring 12 months or more after an individual's last menstrual period. It is important for women to recognize abnormal symptoms during menopause, with PMB being one of the most critical. PMB is a common clinical presentation and can be indicative of endometrial carcinoma. A thorough clinical assessment and endometrial histopathology can ensure early diagnosis and treatment of malignancy in high-risk patients. Materials and Methods This study included 120 women with PMB. Their clinical and histopathological characteristics were studied, and correlations between the characteristics were investigated. Patients were evaluated according to their age, parity, duration of menopause, and socioeconomic status. Various comorbidities such as diabetes mellitus, hypertension, and obesity were noted. Results The patients ranged in age from 45 to 80 years, with a mean age of 54.97 ± 5.86 years. Fifty-nine (49.16%) of the patients presented with PMB within 3 years of menopause. PMB was seen most commonly in patients with parity 3, accounting for 37 (30.83%) of the cases. Endometrial thickness was increased in 100 (83.33%) cases. The most common causes of PMB were simple hyperplasia without atypia (SHWOA) in 36 (36%) patients and atrophic endometrium in 14 (14%) patients. Twelve (10%) of the patients had endometrial carcinoma. Benign causes of PMB were present in 91 (75.3%) cases, whereas 29 (24.1%) had a malignant cause. Weakly positive, but significant correlations (P < 0.05) were seen between the development of malignancy and increasing age (Pearson correlation coefficient, r = 0.263) parity (r = 0.244), and body mass index (r = 0.272). Conclusions PMB is considered abnormal. Benign causes are more common, but malignant causes are possible. In the current study, endometrial carcinoma was the most common malignant cause of PMB. Endometrial carcinoma incidence increased with greater endometrial thickness and more years since menopause. Histopathological examination remains the criterion standard for the correct diagnosis. Initiatives are recommended for increasing awareness about PMB to support prompt medical attention for a better prognosis.
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Affiliation(s)
- Shailja Talwar
- Department of Obstetrics and Gynecology, Community Health Center, Khamanon, IND
| | - Harpreet Kaur
- Department of Obstetrics and Gynecology, Guru Gobind Singh Medical College and Hospital, Faridkot, IND
| | - Isha Tapasvi
- Department of Obstetrics and Gynecology, Guru Gobind Singh Medical College and Hospital, Faridkot, IND
| | - Sarita Nibhoria
- Department of Pathology, Guru Gobind Singh Medical College and Hospital, Faridkot, IND
| | - Chaitanya Tapasvi
- Department of Radiodiagnosis, Guru Gobind Singh Medical College and Hospital, Faridkot, IND
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Rotenberg O, Doulaveris G, Fridman D, Renz M, Kaplan J, Xie X, Goldberg GL, Dar P. Risk of endometrial polyp and surgical intervention in postmenopausal women with proliferative endometrium. Maturitas 2023; 178:107847. [PMID: 37717294 DOI: 10.1016/j.maturitas.2023.107847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/10/2023] [Accepted: 09/05/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE To study the long-term risks of postmenopausal women with proliferative endometrium developing benign uterine pathologies (endometrial polyps and uterine fibroids) and requiring future gynecological interventions, and to compare them with women with atrophic endometrium. DESIGN Retrospective cohort study of all women aged 55 or over who underwent endometrial biopsy between 1/1997 and 12/2008. Outcome data were available through to 2/2018. Women with proliferative endometrium were compared with those with atrophic endometrium for the presence of endometrial polyps, uterine fibroids, future endometrial biopsy for recurrent vaginal bleeding, and future hysteroscopy or hysterectomy. Logistic regression models were used to evaluate the association of endometrial histology and other covariates with the risk of morbidities. MAIN FINDINGS Postmenopausal women with proliferative endometrium are at higher risk of developing endometrial polyps, uterine fibroids and need for surgical intervention. Of 1808 women who underwent endometrial biopsy during the study period, 962 met inclusion criteria: 278 had proliferative and 684 had atrophic endometrium. Length of surveillance was similar in the two groups (11.9 vs. 11.5 years, p = 0.2). Compared with women with atrophic endometrium, women with proliferative endometrium had significantly higher rates of endometrial polyps (17.3 % vs 9.7 % p = 0.001). Multivariable logistic regression confirmed that women with proliferative endometrium had more fibroids on ultrasound (62.1 % vs 50.3 % 3 = 0.02), and had increased risks of developing endometrial polyps (aOR 1.9, 95 % CI 1.28-3.07, p = 0.002), repeat endometrial biopsy (34.9 % vs. 16.8%p < 0.001) and future hysterectomy or hysteroscopy (26.6 % vs 16.2 % p < 0.001). CONCLUSIONS In addition to the long-term increased risk of cancer, postmenopausal women with proliferative endometrium are more likely to have future bleeding, surgical interventions and diagnosis of endometrial polyps. Medical management to reduce estrogenic activity and associated risks may be considered in these cases.
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Affiliation(s)
- Ohad Rotenberg
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Canter, Bronx, NY, USA.
| | - Georgios Doulaveris
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Canter, Bronx, NY, USA
| | - Dmitry Fridman
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Canter, Bronx, NY, USA
| | - Malte Renz
- Department of Obstetrics & Gynecology, Gynecologic Oncology, Stanford University, Stanford, CA, USA
| | - Julie Kaplan
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Canter, Bronx, NY, USA
| | - Xianhong Xie
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Canter, Bronx, NY, USA
| | - Gary L Goldberg
- Department of Obstetrics & Gynecology, Gynecologic Oncology, Northwell Health, LIJ Medical Center, New Hyde Park, NY, USA
| | - Pe'er Dar
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Canter, Bronx, NY, USA
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Alqahtani NH, Albayat MI, Al Nashwan YA, Alnemer AM. Pathologic Profile of Hysterectomy Cases in Saudi Arabia: A Tertiary Center Experience. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2023; 11:257-263. [PMID: 37533661 PMCID: PMC10393089 DOI: 10.4103/sjmms.sjmms_438_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/24/2022] [Accepted: 06/13/2023] [Indexed: 08/04/2023]
Abstract
Background Hysterectomies are increasingly being replaced by more conservative management modalities and are now only used for limited clinical indications. The agreement between these indications and the final pathology is understudied. Objectives This study aimed to correlate the preoperative clinical diagnoses with the pathological findings detected in hysterectomies in Saudi women of different age groups. Materials and Methods This retrospective study analyzed the preoperative clinical indications and the subsequent clinical and pathological data of all hysterectomies conducted at a single tertiary care hospital in the Eastern Province of Saudi Arabia between January 2010 and December 2021. Results There was no decline in the frequency of hysterectomies across the study period. Abnormal uterine bleeding was the most common clinical indication across all age groups, followed by symptomatic fibroid and uterine prolapse in women aged <50 and ≥50 years, respectively. A total of 9.2% of the cases were indicated for therapeutic reasons, either as an emergency procedure for peripartum hemorrhage or for suspected uterine premalignant and malignant lesions. Besides these, 41.2% of patients had more than one pathology, with the most common combination being leiomyoma and adenomyosis (43.4%). The difference in age between malignant and benign cases (52.3 vs. 48.8 years, respectively) was not statistically significant (P = 0.109). Conclusions Most of our cohort had benign lesions. Perceptible misuse of the procedure in this cohort was unlikely, as a large proportion of the patients had more than one pathology corresponding to each clinical indication.
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Affiliation(s)
- Nourah Hasan Alqahtani
- Department of Obstetrics and Gynecology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Methal I. Albayat
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Yara A. Al Nashwan
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Areej Manssour Alnemer
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Endometrial Thickness (ET) by TVS and its Correlation with HPE by Endometrial Aspiration Biopsy in Postmenopausal Bleeding. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2023. [DOI: 10.1007/s40944-022-00696-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Cruz García AM, Pérez Morales E, Ocón Padrón L, Pérez Matos C, Santana Suárez A, Emergui Zrihen Y, Nieto Naya MÁ, Sánchez Sánchez V, Martín Martínez A. Asymptomatic endometrial thickening in postmenopausal women: predictor of malignant pathology? J OBSTET GYNAECOL 2022; 43:2160928. [PMID: 36576124 DOI: 10.1080/01443615.2022.2160928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
It is not standardised what is the endometrial thickness that discriminates between normal and potentially malignant. The objective of this study was to determine the endometrial thickness cut-off point from which the risk of endometrial cancer (EC) increases in asymptomatic postmenopausal women; and to evaluate the risk factors linked to malignant endometrial pathology as well as other associated ultrasound findings.This was a retrospective observational study that included hysteroscopies performed at the Hospital Materno-Infantil on 267 asymptomatic menopausal women with an increase in endometrial thickness (AET) >5 mm, from 2015 to 2019. The results shows that the prevalence of malignant pathology in asymptomatic postmenopausal women with a casual finding of endometrial thickening was 3.7%. This percentage was 16.3% when the cut-off point of AET was established at 10 mm. There was a significant association for the diagnosis of malignant pathology with this cut-off point.There is a significant association between the 10 mm endometrial thickness cut-off point from which the risk of EC increases in asymptomatic postmenopausal women.Impact statementWhat is already known on this subject? Several studies have established the cut-off point for asymptomatic endometrial thickening (AET) for atypical endometrial hyperplasia and endometrial cancer at 10 mm. Although no cut-off point has optimal accuracy for the diagnosis of malignant endometrial pathology, it has been found that with a cut-off value of AET >10 mm no cases are missed. Likewise, a cut-off point of AET > 11 mm may provide a balance between cancer detection and histopathological workup extension.What do the results of this study add? A significant association was found at the cut-off point of AET > 10 mm, which suggests that screening postmenopausal women at this thickness is acceptable and unlikely to miss cases of endometrial hyperplasia and endometrial cancer.What are the implications of these findings for clinical practice and/or further research? After analysing our results we can conclude, like other published studies, that by establishing a cut-off point of 10 mm we obtain a good discrimination between benign and malignant pathology, which would allow us to diagnose 100% of malignant pathology. Above this cut-off point, the risk of endometrial cancer increases, and it would therefore be advisable to extend the study. A multicentre study is needed to confirm the cut-off point at which the risk of endometrial cancer increases in postmenopausal women with asymptomatic endometrial thickening.
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Affiliation(s)
- Alba María Cruz García
- Service of Gynaecology and Obstetrics, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Elena Pérez Morales
- Service of Gynaecology and Obstetrics, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Ludmila Ocón Padrón
- Service of Gynaecology and Obstetrics, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Cristina Pérez Matos
- Service of Gynaecology and Obstetrics, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Alejandra Santana Suárez
- Service of Gynaecology and Obstetrics, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Yonit Emergui Zrihen
- Service of Gynaecology and Obstetrics, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - María Ángeles Nieto Naya
- Service of Gynaecology and Obstetrics, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Victoria Sánchez Sánchez
- Service of Gynaecology and Obstetrics, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Alicia Martín Martínez
- Service of Gynaecology and Obstetrics, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
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Clinicopathological features of endometrial lesions in asymptomatic postmenopausal women with thickened endometrium. Menopause 2022; 29:952-956. [PMID: 35881941 DOI: 10.1097/gme.0000000000001993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the clinical and pathological features of asymptomatic postmenopausal women with an incidentally detected increase in endometrial thickness (ET) by transvaginal ultrasound examination and discuss the cutoff value of ET for the timely discovery of endometrial malignancy. METHODS This was a retrospective study of postmenopausal women with asymptomatic thickened endometrium (greater than or equal to 5 mm) screened by transvaginal ultrasound who were referred to the gynecology department at Xuanwu Hospital between January 2018 and March 2021. Data on participant demographics, clinical characteristics, and histopathology outcomes were collected. We stratified the participants into the benign group and malignant group according to pathology results and assessed differences between the two groups. A receiver operating characteristic curve was used to identify the cutoff value of ET for predicting endometrial malignancy in postmenopausal women with asymptomatic thickened endometrium. RESULTS A total of 163 eligible cases were included in the analysis. The results showed that only ET was significantly different between the two groups. The median ET was significantly higher in the malignant group than in the benign group (1.20 vs 0.80, P = 0.023). The optimal cutoff value of ET was 10 mmwith the maximum AUC (0.881, 95% CI 0.810-0.952, P = 0.024), and the sensitivity and specificity for the diagnosis of endometrial malignancy were 100%and 80%, respectively. Among the 47 women with ET ≥ 10mm, the prevalence of endometrial malignancy was 6.3%, which was significantly higher than that among women with ET < 10mm ( P = 0.023). CONCLUSION For postmenopausal women with asymptomatic endometrial thickening, the prevalence of endometrial malignancy is significantly higher when ET is ≥ 10 mm. If ET is ≥ 10mm, further histopathological testing should be recommended to exclude endometrial malignancy. Further large-sample and prospective studies are needed to determine the predictive value of ET.
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Andersen NJ, Parker JL, Pettigrew S, Bitner D. Validation of the Menopause Transition Scale (MTS). Menopause 2022; 29:868-876. [DOI: 10.1097/gme.0000000000001975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Grcevich LO, O'Connell A, Jabaay MJ, Scott JT. Postmenopausal Uterine Leiomyomas and Chronic Lymphadenopathy: Exploring Epigenetic Changes and Pathophysiology. Cureus 2021; 13:e18274. [PMID: 34722052 PMCID: PMC8545538 DOI: 10.7759/cureus.18274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/25/2021] [Indexed: 12/05/2022] Open
Abstract
Uterine leiomyomas (LM) are tumors arising from the non-neoplastic proliferation of smooth muscle cells within the myometrium. Like benign tumors, LM are not generally spread through the lymphatic system, and therefore should not be associated with lymphadenopathy. Herein, we present a case of a 60-year-old female who presented to the clinic with postmenopausal bleeding in the setting of sonographically evident uterine LM and abdominal lymphadenopathy. A lymph node biopsy revealed plasma cells and an eosinophilic material presumptively diagnosed as amyloid. She then underwent an abdominal hysterectomy for definitive treatment of LM. Surgical pathology confirmed the clinical diagnosis of uterine and cervical leiomyoma. Current literature suggests that genetic and epigenetic abnormalities contribute to the pathogenesis of LM in addition to hormonal signals such as estrogen and progesterone. It is unusual for LM to occur in post-menopausal women due to reduced hormonal influence. Therefore, this case explored an alternative mechanism of tumor proliferation. This case hypothesizes that genetic mutations and epigenetic changes resulting from chronic inflammatory offenses contributed to LM growth and lymphadenopathy.
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Affiliation(s)
- Leah O Grcevich
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Alexis O'Connell
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Maxwell J Jabaay
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA
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Histopathological Findings in Iranian Patients with Postmenopausal Uterine Bleeding. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-021-00515-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Kale I, Topal CS. A rare cause of postmenopausal bleeding: chronic lymphocytic leukemia. Climacteric 2021; 25:103-105. [PMID: 33955311 DOI: 10.1080/13697137.2021.1917540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Postmenopausal bleeding has been reported in about 4-11% of menopausal women. The most common cause of postmenopausal bleeding is atrophy of the vaginal mucosa or endometrium. Endometrial hyperplasia, endometrial polyps, submucous leiomyomas and endometrial cancers are also known causes of postmenopausal bleeding. Here, we present a patient whose cause of postmenopausal vaginal bleeding was infiltration of the endometrium with chronic lymphocytic leukemia (CLL). CASE REPORT A 78-year-old woman, who has been followed up with a diagnosis of CLL for 5 years, presented with a complaint of postmenopausal bleeding. After dilation and curettage, pathology revealed that the cause of the postmenopausal bleeding was CLL infiltration into the endometrium. CONCLUSION Any involvement of the female genital organs in CLL is rare. Therefore, hematological malignancies should be considered in the differential diagnosis of postmenopausal bleeding.
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Affiliation(s)
- I Kale
- Department of Obstetrics and Gynaecology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Cumhur Selçuk Topal
- Department of Pathology, Umraniye Training and Research Hospital, Istanbul, Turkey
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Haimovich S, Tanvir T. A Mini-Review of Office Hysteroscopic Techniques for Endometrial Tissue Sampling in Postmenopausal Bleeding. J Midlife Health 2021; 12:21-29. [PMID: 34188422 PMCID: PMC8189338 DOI: 10.4103/jmh.jmh_42_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 03/20/2021] [Accepted: 03/28/2021] [Indexed: 11/20/2022] Open
Abstract
Postmenopausal bleeding (PMB) is a common cause for a gynecological visit. Endometrial cancer risk varies from 3% to 25% in women with PMB. There is a significant concern of malignancy of the endometrium and the endocervical canal by a physician in postmenopausal women, and hence, most prefer operating room hysteroscopies with dilation and curettage (D & C) compared to in-office procedures. With increased availablility of miniaturized instruments such as mini- resectoscope and tissue removal systems, there is high likelihood of blind D & C being replaced by hysteroscopic- guided targetted biopsy or visual D & C. The cost-effectiveness of office hysteroscopy is also well demonstrated. In December 2020, an electronic search was performed of PubMed, MEDLINE, and Cochrane Library to look for articles on office hysteroscopic biopsy techniques in postmenopausal women from 2010 to 2020. Relevant studies were included where various office hysteroscopic techniques are used for endometrial sampling in PMB. Studies with 5 Fr scissors, biopsy forceps, crocodile forceps, cup forceps, bipolar electrode, in-office tissue removal system (morcellator), flexible hysteroscope, and mini-resectoscope were included. Standard reference was used as an adequate endometrial sample for histology. The objective of this review is to explore the current evidence on different office hysteroscopic techniques available for endometrial tissue sampling in PMB.
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Affiliation(s)
- Sergio Haimovich
- Department of Obstetrics and Gynecology, Del Mar University Hospital, Barcelona, Spain
| | - Tanvir Tanvir
- Department of Obstetrics and Gynecology, Tanvir Hospital, Hyderabad, Telangana, India
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Swain M, Kulkarni A. Endometrium at menopause: The pathologist's view. J Midlife Health 2021; 12:310-315. [PMID: 35264839 PMCID: PMC8849152 DOI: 10.4103/jmh.jmh_218_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 11/04/2022] Open
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Rotenberg O, Doulaveris G, Fridman D, Renz M, Kaplan J, Xie X, Goldberg GL, Dar P. Long-term outcome of postmenopausal women with proliferative endometrium on endometrial sampling. Am J Obstet Gynecol 2020; 223:896.e1-896.e7. [PMID: 32640199 DOI: 10.1016/j.ajog.2020.06.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Proliferative endometrium has been reported in 15% of endometrial biopsies of women aged 50 years and older. Contrary to endometrial hyperplasia, proliferative endometrium has not been associated with the risk of endometrial cancer. OBJECTIVE This study aimed to report on the long-term outcome of postmenopausal women who received a diagnosis of proliferative endometrium. STUDY DESIGN This is a retrospective cohort study of 1808 women aged 55 years and older who underwent endometrial sampling between January 1997 and December 2008. Outcome data were available through February 2018. Women with a proliferative endometrium were compared with those with an atrophic endometrium for future development of endometrial hyperplasia or cancer. A subanalysis was performed for those who presented with postmenopausal bleeding. Uni- and multivariable logistic regression analyses were used to assess for confounders. RESULTS In this study, 297 women (16.4%) received a diagnosis of proliferative endometrium. Furthermore, 962 women met the inclusion criteria. Among those women, 278 had a proliferative endometrium, and 684 had an atrophic endometrium. Women with a proliferative endometrium were younger (61.2 vs 64.5 years; P<.0001) and had a higher body mass index (33.9 vs 30.6 kg/m2; P<.0001). More African American women had a proliferative endometrium. Both groups had a similar length of surveillance (11.9 vs 11.5 years; P=.27). Women with a proliferative endometrium had a higher risk of developing endometrial hyperplasia or cancer (11.9% vs 2.9%; P<.0001), any endometrial cancer (5.8% vs 1.8%; P=.002), atypical endometrial hyperplasia (2.2% vs 0.4%; P=.02), and nonatypical endometrial hyperplasia (2.0% vs 0.7%; P=.001). The risk of developing endometrial cancer and endometrial hyperplasia remained similar after excluding cases on hormonal replacement therapy (12.2% vs 3%; P=.001). On logistic regression analysis, proliferative endometrium histology (odds ratio, 3.89; 95% confidence interval, 2.03-7.49; P<.0001), age >60 years (odds ratio, 1.98; 95% confidence interval, 1.03-3.82; P=.04), and body mass index >35 kg/m2 (odds ratio, 2.3; 95% confidence interval, 1.09-4.83; P<.0001) remained significant risk factors for progression to cancer. CONCLUSION One of the 6 postmenopausal women who underwent endometrial sampling had a proliferative endometrium. Furthermore, 11.9% of women developed endometrial hyperplasia or cancer, a 4-fold greater incidence than women with an atrophic endometrium. The findings of this study suggest that long-term monitoring is warranted for women with postmenopausal bleeding and a proliferative endometrium histology. Further studies are needed to examine if a treatment is required to negate the risk of unopposed estrogen.
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Fagioli R, Vitagliano A, Carugno J, Castellano G, De Angelis MC, Di Spiezio Sardo A. Hysteroscopy in postmenopause: from diagnosis to the management of intrauterine pathologies. Climacteric 2020; 23:360-368. [PMID: 32396739 DOI: 10.1080/13697137.2020.1754387] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
With the increase in life expectancy, women now live up to one-third of their life in menopause. Postmenopausal bleeding (PMB) is a common gynecologic complaint encountered by the clinician. Endometrial cancer is present in about 10% of patients with PMB. Nevertheless, many other conditions such as endometrial or cervical polyps, genital atrophy, or non-gynecologic conditions may also be present. Hysteroscopy has replaced blind diagnostic procedures and is now considered the gold-standard technique for the diagnosis and management of intrauterine pathology. Gynecologists in clinical practice should be familiar with the use of hysteroscopy in the diagnosis and treatment of the menopausal patient presenting with gynecologic complaints. The aim of this article is to report the current evidence on the role of hysteroscopy in the evaluation and management of the postmenopausal patient with intrauterine pathology.
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Affiliation(s)
- R Fagioli
- Department of Obstetrics, Gynecology, Urology Sciences and Reproductive Medicine, University of Naples Federico II, Naples, Italy
| | - A Vitagliano
- Unit of Gynecology and Obstetrics, Department of Women and Children's Health, University of Padua, Padua, Italy
| | - J Carugno
- Obstetrics, Gynecology and Reproductive Sciences Department, Minimally Invasive Gynecology Unit, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - G Castellano
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - M C De Angelis
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - A Di Spiezio Sardo
- Department of Public Health, University of Naples Federico II, Naples, Italy
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17
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Allam MM, Allam MS, Mehasseb MK. Recurrent postmenopausal bleeding: a survey of practice among gynecologists in Scotland. ACTA ACUST UNITED AC 2020; 72:64-69. [PMID: 32403905 DOI: 10.23736/s0026-4784.20.04432-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The definition and management of recurrent postmenopausal bleeding (PMB) are not well described in the literature, with no consensus among the clinicians and no available contemporary UK evidence-based guidelines. We conducted this survey to examine the practice of gynecologists based in Scotland in relation to recurrent postmenopausal bleeding. METHODS A web-based questionnaire was sent to 200 non-training grade gynecologists in Scotland exploring their views on the definition, investigation and management of recurrent PMB. Data were extracted from the 61 responses received. RESULTS Seventy-seven percent of responders defined recurrent PMB as two or more episodes of PMB, while 21% defined it after three episodes. A bleed-free interval of 3 and 6 months was needed to identify a recurrence by 46% and 44% of responders, respectively. 70% would investigate recurrent PMB with a combination of transvaginal sonography, hysteroscopy and biopsy. Only 19% would arrange a pelvic MRI routinely, while 43% would never offer one. 72% would consider a hysterectomy at some stage, with 22% of responders offering it after 3 episodes of PMB with negative investigation. 18% would never offer a hysterectomy without an identified pathology. 32% of responders felt that the management of recurrent PMB required an individualized case-by-case approach. CONCLUSIONS This survey highlights the need for a clinical guideline to address the wide variation in the management of recurrent PMB.
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Affiliation(s)
- Marwa M Allam
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Mohammed S Allam
- Department of Obstetrics and Gynecology, University Hospital of Wishaw, Wishaw, UK
| | - Mohamed K Mehasseb
- Department of Gynecological Oncology, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK -
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Meeta M, Digumarti L, Agarwal N, Vaze N, Shah R, Malik S. Clinical Practice Guidelines on Menopause: *An Executive Summary and Recommendations: Indian Menopause Society 2019-2020. J Midlife Health 2020; 11:55-95. [PMID: 33281418 PMCID: PMC7688016 DOI: 10.4103/jmh.jmh_137_20] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Meeta Meeta
- Gynecologist, Co-Director and Chief Consultant, Tanvir Hospital, Hyderabad, Telangana, India
| | - Leela Digumarti
- Gynecologist, Homi Bhabha Cancer Hospital and Research Centre, Aganampudi, Visakhapatnam, Andhra Pradesh, India
| | - Neelam Agarwal
- Obs Gynae, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Nirmala Vaze
- Consultant Obstetrician/Gynaecologist, Counselar Breast, Gynae Cancer & Menopause, Nagpur, India
| | - Rashmi Shah
- Gynecologist, Ex Senior Deputy Director, National Institute for Research in Reproductive Health (ICMR), Mumbai, India
| | - Sonia Malik
- Gynecologist, Director and HOD, Southend Fertility & IVF Centre, New Delhi, India
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Clinical and Sonographic Evaluation of Postmenopausal Bleeding (PMB) Followed by Diagnostic and/or Therapeutic Hysteroscopy and Guided Biopsy in Jordanian Hospitals. MEDICINA-LITHUANIA 2020; 56:medicina56040147. [PMID: 32218372 PMCID: PMC7230468 DOI: 10.3390/medicina56040147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 02/07/2023]
Abstract
Background and Objectives: The goal of this study was to evaluate the clinical sonographic evaluation of postmenopausal bleeding (PMB) followed by diagnostic and/or therapeutic hysteroscopy and guided biopsy in Jordanian hospitals. Materials and Methods: A retrospective multi-centric study was performed in hospitals in Al-Karak and Amman from 2014-2016. The study recruited 189 cases to evaluate the aetiology of postmenopausal bleeding. Atrophic endometrium was observed as a major cause of postmenopausal bleeding according to histopathology. The cases were also distributed according to parity in which nulliparous patients were observed. Results: Hysteroscopy was observed to be effective for the diagnosis of postmenopausal bleeding. Conclusion: There is a need to assess more approaches for the diagnosis of postmenopausal bleeding among women.
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Sun J, Guo Y, Ma L, Qian Z, Lai D. An unusual cause of postmenopausal vaginal haemorrhage: a case report. BMC WOMENS HEALTH 2019; 19:31. [PMID: 30732650 PMCID: PMC6367833 DOI: 10.1186/s12905-019-0731-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/30/2019] [Indexed: 11/15/2022]
Abstract
Background Post-menopause vaginal haemorrhage is typically related to gynaecological malignancies. Bleeding from vaginal varices rarely occurs, especially in nonpregnant women. Moreover, nonpregnancy-related causes of vaginal varicosities include portal hypertension, especially that caused by liver cirrhosis, pelvic congestion syndrome and Klippel-Trenaunay syndrome or Parkes-Weber syndrome. Here, we report an unusual cause of nonpregnancy-associated vaginal variceal bleeding. Case presentation A 55-year-old postmenopausal woman presented in our outpatient department with complaints of recurrent bloody vaginal discharge. A group of varicose veins and several haemorrhagic spots were found on her vaginal wall during a vaginal speculum examination. Genital cancers were excluded by colposcopy and transvaginal ultrasonography; furthermore, a pelvic arteriovenous fistula was not found on a pelvic computed tomography (CT) scan. However, congenital varicosities and deep arteriovenous shunts were observed in her left leg on arterial angiography. Moreover, vaginal bleeding was improved after resolution of the underlying deep arteriovenous shunts in her left leg. Therefore, congenital arteriovenous shunts and elevated inferior vena cava pressure might be responsible for her recurrent vaginal varicose bleeding. Conclusion Haemorrhage due to vaginal varices is easily detected with a vaginal speculum examination. However, diagnosis and treatment of the original disease are important after bleeding is controlled.
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Affiliation(s)
- Junyan Sun
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, 145, Guang-yuan Road, Xuhui District, Shanghai, 200030, China
| | - Ying Guo
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, 145, Guang-yuan Road, Xuhui District, Shanghai, 200030, China
| | - Li Ma
- Zhangshan Hospital, Fudan University, 180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Zhaoxia Qian
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, 145, Guang-yuan Road, Xuhui District, Shanghai, 200030, China
| | - Dongmei Lai
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, 145, Guang-yuan Road, Xuhui District, Shanghai, 200030, China.
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21
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The incidence and predictors of gynecologic malignancies among postmenopausal patients with endometrial fluid collection. Arch Gynecol Obstet 2018; 299:1071-1076. [PMID: 30519752 DOI: 10.1007/s00404-018-4997-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To investigate the incidence and predictors of gynecologic malignancies among postmenopausal patients with endometrial fluid collection (EFC). METHODS All patients with EFC diagnosed by transvaginal sonography (TVS) were retrospectively reviewed if they had undergone biopsy of the endometrium from January 2008 to January 2016 in a tertiary teaching hospital. Follow-up ended in June 2017. The incidence of gynecologic malignancies was described, and predictive factors were determined by comparing the epidemiological and clinico-pathological characteristics of the patients. RESULTS During the study period, 273 women with EFC (3.4%) were enrolled. Biopsy pathology and the following hysterectomy revealed 29 (10.6%) cases of gynecological cancer. In the multivariable analysis, patient-reported genital symptoms [odds ratio (OR) 16.2, 95% confidence interval (CI) 1.9-139.3], abnormal serum CA125 (OR 14.5, 95% CI 4.5-46.5), lesions in the uterine cavity (OR 18.8, 95% CI 6.0-59.1) and endometrial thickness (OR 1.1, 95% CI 1.0-1.2) determined by TVS were independent factors associated with malignancy. Only 1.1% (1/90) of the asymptomatic patients had gynecologic cancer. During the follow-up, gynecologic cancer was diagnosed in nine patients, six of whom had vaginal bleeding at the time of initial enrollment. The prognosis of patients with cancer was worse than that of patients with benign results. CONCLUSION The risk of gynecologic malignancies in postmenopausal patients with EFC is related to genital symptoms, TVS findings and CA 125 levels. Asymptomatic EFC is associated with an extremely low risk of malignancy.
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Li F, Wei S, Yang S, Liu Z, Nan F. Post hysteroscopic progesterone hormone therapy in the treatment of endometrial polyps. Pak J Med Sci 2018; 34:1267-1271. [PMID: 30344589 PMCID: PMC6191810 DOI: 10.12669/pjms.345.15330] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 09/04/2018] [Accepted: 09/06/2018] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To find out the clinical effects of post hysteroscopic progesterone hormone therapy in the treatment of endometrial polyps in terms of clinical outcome and the expression of endometrial Vascular Endothelial Growth Factor (VEGF). METHODS Ninety-eight patients who were confirmed as endometrial polyp in the hospital from April 2014 and December 2016 were selected and divided into treatment group and a control group using random number table, 49 in each group. Patients in both groups were given hysteroscopic operation. Patients in the treatment group were treated by progesterone hormone drugs after hysteroscopic operation, while patients in the control group were not given progesterone hormone. The changes of menstrual blood volume, menstrual cycle and expression of VEGF were compared between the two groups after treatment, and the recurrence condition, thickness of endometrium and hemoglobin were followed up one year after treatment. RESULTS The pictorial blood loss assessment chart (PBAC) scores of patients in the two groups had no significant difference before treatment (P>0.05); but the score of the treatment group was much lower than that of the control group. The improvement rate of menstrual cycle of the treatment group was much higher than that of the control group, and the difference had statistical significance (P<0.05). Compared to before treatment, the serum VEGF level of the patients in both groups had a remarkable decline in the 1st, 3rd and 6th month after treatment, and the difference had statistical significance (P<0.05). The difference of the serum VEGF level between the two groups in the 1st and 3rd month after treatment had no statistical significance (P>0.05). The serum VEGF level of the treatment group was notably lower than that of the control group six months after treatment, and the difference had statistical significance (P<0.05). The follow-up results demonstrated that the treatment group had smaller thickness of endometrium and higher level of hemoglobin compared to the control group, and the recurrence rate of the treatment group was lower than that of the control group (P<0.05). CONCLUSION Post hysteroscopic progesterone hormone therapy has favorable clinical effect in treating endometrial polyps as it can effectively prevent the recurrence of endometrial polyps, relieve the level of hemoglobin and reduce endometrial thickness.
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Affiliation(s)
- Fangfang Li
- Fangfang Li, Department of Obstetrics and Gynecology, Binzhou Medical University Hospital, Binzhou, 256603, China
| | - Shuangyan Wei
- Shuangyan Wei, Department of Obstetrics and Gynecology, Binzhou Medical University Hospital, Binzhou, 256603, China
| | - Shuye Yang
- Shuye Yang, Department of Orthopaedics, Binzhou Medical University Hospital, Binzhou, 256603, China
| | - Zhiqiang Liu
- Zhiqiang Liu, Department of Obstetrics and Gynecology, Binzhou Medical University Hospital, Binzhou, 256603, China
| | - Fangfang Nan
- Fangfang Nan, Department of Obstetrics and Gynecology, Binzhou Medical University Hospital, Binzhou, 256603, China
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Gnanachandran C, Zielinski E, Penketh R. Survey on Selection Criteria Indication for Patients with Postmenopausal Bleeding for Hysteroscopy: Variation in Current Practice and Implications for Clinical Effectiveness. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2018.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Evelyn Zielinski
- Department of Obstetrics and Gynaecology, University Hospital of Leicester, Leicester, UK
| | - Richard Penketh
- Department of Gynaecology, Cardiff and Vale University Health Board, Cardiff, UK
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24
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Sánchez Barrancos IM, Guerrero García FJ, Rico López MDC, Fernández Rodríguez V, Vegas Jiménez T, Alonso Roca R, Domínguez Tristancho D. [Usefulness and reliability of abdominal point of care ultrasound in family practice (2): Large abdominal vessels, spleen, nephrourological and gynecological ultrasound]. Aten Primaria 2018; 50:430-442. [PMID: 29858122 PMCID: PMC6837077 DOI: 10.1016/j.aprim.2018.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 02/26/2018] [Indexed: 10/28/2022] Open
Abstract
This article is a continuation of the review initiated in the previous issue about the usefulness of point of care ultrasound in Primary Care, completing the scenarios of large abdominal vessels, spleen, nephrourological and gynecological ultrasound.
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Affiliation(s)
- Ignacio Manuel Sánchez Barrancos
- Médico especialista en Medicina Familiar y Comunitaria; Miembro del Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Consultorio local de Membrilla, Centro de Salud Manzanares 2, Gerencia de Atención Integrada de Manzanares, Ciudad Real, España.
| | - Francisco José Guerrero García
- Médico especialista en Medicina Familiar y Comunitaria; Miembro del Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Unidad de Gestión Clínica Gran Capitán, Distrito Sanitario Granada Metropolitano, Granada, España
| | - María Del Carmen Rico López
- Médico especialista en Medicina Familiar y Comunitaria; Miembro del Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro Médico Adeslas, Almería, España
| | - Vicente Fernández Rodríguez
- Médico especialista en Medicina Familiar y Comunitaria; Miembro del Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Salud Os Rosales, Estructura Organizativa de Xestión Integrada, A Coruña, España
| | - Tomás Vegas Jiménez
- Médico especialista en Medicina Familiar y Comunitaria; Miembro del Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Salud San Fernando, Gerencia de Atención Primaria de Badajoz, Badajoz, España
| | - Rafael Alonso Roca
- Médico especialista en Medicina Familiar y Comunitaria; Miembro del Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Salud Mar Báltico, Área Este, Madrid, España
| | - Daniel Domínguez Tristancho
- Médico especialista en Medicina Familiar y Comunitaria; Miembro del Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Salud Santa Marta de los Barros, Gerencia de Atención Primaria de Badajoz, Badajoz, España
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25
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Ghoubara A, Emovon E, Sundar S, Ewies A. Thickened endometrium in asymptomatic postmenopausal women – determining an optimum threshold for prediction of atypical hyperplasia and cancer. J OBSTET GYNAECOL 2018; 38:1146-1149. [PMID: 29862866 DOI: 10.1080/01443615.2018.1458081] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Ahmed Ghoubara
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Obstetrics and Gynaecology Department, Aswan University, Aswan, Egypt
- Gynaecology Department, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Emmanuel Emovon
- Gynaecology Department, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Sudha Sundar
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Gynaecology Department, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Ayman Ewies
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Gynaecology Department, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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Ghoubara A, Sundar S, Ewies AAA. Endometrial pathology in recurrent postmenopausal bleeding: observational study of 385 women. Climacteric 2018; 21:391-396. [PMID: 29741102 DOI: 10.1080/13697137.2018.1461825] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- A. Ghoubara
- University of Birmingham, Birmingham, UK
- Department of Obstetrics and Gynecology, Aswan University, Aswan, Egypt
- Gynaecology Department, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - S. Sundar
- University of Birmingham, Birmingham, UK
- Gynaecology Department, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - A. A. A. Ewies
- University of Birmingham, Birmingham, UK
- Gynaecology Department, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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Abstract
Giant polyp is an unusual female genital tract pathology, commonly arising from the cervix than the endometrium. It is a great masquerader of cervical or endometrial malignancy and can lead to a diagnostic dilemma and unnecessary aggressive interventions. Experience in one such case of an extremely rare protruding giant endometrial polyp in a 58-year-old postmenopausal female is being described herewith so as to create awareness among the dealing clinicians. The approach to such a case, differential diagnosis, and review of the literature is also presented.
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Affiliation(s)
- Sonam Sharma
- Department of Pathology, Kalpana Chawla Government Medical College, Karnal, Haryana, India
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28
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Kim MK, Jung YS, Chon SJ, Yun BH, Cho S, Choi YS, Lee BS, Seo SK. Common Causes of Postmenopausal Bleeding in Korean Women: 10-Year Outcomes from a Single Medical Center. J Korean Med Sci 2017; 32:830-834. [PMID: 28378558 PMCID: PMC5383617 DOI: 10.3346/jkms.2017.32.5.830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 01/30/2017] [Indexed: 11/20/2022] Open
Abstract
The common causes of postmenopausal bleeding (PMB), according to the data from the western world, are atrophy, hormone replacement therapy (HRT), endometrial cancer, etc. We conducted a retrospective study to assess whether the causes of PMB in Korean postmenopausal women are similar to those already known. This retrospective study used 10-year medical records (March 2005 to December 2014) of 792 PMB women in the Yonsei University Health System. The data were divided into 2 categories by 5-year intervals to compare the differences between the 2 periods. The most common cause of PMB in Korean women was atrophy (51.1%). Polyps and HRT were the second, followed by anticoagulant medications, cervical cancer, and endometrial cancer. The proportion of patients with cervical cancer significantly decreased during the second half of the decade (8.7% vs. 5.2%; P = 0.048). Although no significant change was noted for HRT, its rank was higher during the latter 5-year period. Only the most common cause of PMB was the same as the conventional data. Interestingly, the proportion of patients with cervical cancer decreased during the latter half of the decade, reflecting the changes in the nation's cancer prevalence rate, while the use of HRT increased.
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Affiliation(s)
- Min Kyoung Kim
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yeon Soo Jung
- Department of Obstetrics and Gynecology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seung Joo Chon
- Department of Obstetrics and Gynecology, Gil Hospital, Gachon University College of Medicine, Incheon, Korea
| | - Bo Hyon Yun
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sihyun Cho
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Sik Choi
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Seok Lee
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Kyo Seo
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.
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29
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Perlman B, Heller D, Cracchiolo B. Interferon beta-1b-induced postmenopausal bleeding in a patient with multiple sclerosis. Climacteric 2016; 19:599-600. [PMID: 27749097 DOI: 10.1080/13697137.2016.1244666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Postmenopausal bleeding must always be evaluated to rule out endometrial carcinoma, although there are many benign etiologies. There have been rare reports of premenopausal bleeding with interferon beta-1b, used to treat multiple sclerosis, but no prior reports in postmenopausal women. METHODS Literature searches were performed using PubMed and Medline for articles with content related to premenopausal and postmenopausal bleeding while taking interferon beta-1b. The searches were restricted to the English language. Search terms included interferon beta-1b and/or uterine hemorrhage and/or vaginal bleeding and/or postmenopausal and/or menopause. RESULTS The literature review found no related articles for postmenopausal bleeding while taking interferon beta-1b. We present a case of a patient with postmenopausal bleeding attributed to elevation of serum estradiol in association with interferon beta-1b therapy. CONCLUSION It is important for patients and providers to be aware of the association between postmenopausal bleeding with the use of interferon beta-1b therapy which could be due to elevated serum estradiol levels.
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Affiliation(s)
- B Perlman
- a Departments of Obstetrics , Gynecology, and Women's Health, Rutgers-New Jersey Medical School , Newark , NJ , USA
| | - D Heller
- a Departments of Obstetrics , Gynecology, and Women's Health, Rutgers-New Jersey Medical School , Newark , NJ , USA.,b Pathology & Laboratory Medicine , Rutgers-New Jersey Medical School , Newark , NJ , USA
| | - B Cracchiolo
- a Departments of Obstetrics , Gynecology, and Women's Health, Rutgers-New Jersey Medical School , Newark , NJ , USA
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Pakish JB, Lu KH, Sun CC, Burzawa JK, Greisinger A, Smith FA, Fellman B, Urbauer DL, Soliman PT. Endometrial Cancer Associated Symptoms: A Case-Control Study. J Womens Health (Larchmt) 2016; 25:1187-1192. [PMID: 27254529 DOI: 10.1089/jwh.2015.5657] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The majority of women with endometrial cancer (EC) present at an early stage with an associated 5-year survival rate of >90%. High rates of early detection are attributed to warning symptoms; however, the prevalence of such symptoms has not been well defined. METHODS A case-control study was conducted assessing the prevalence of symptoms in EC patients at a large cancer center compared with healthy controls. Controls included patients seen for an annual gynecologic care visit (AV) or for a gynecological problem-based visit (PV). A self-administered questionnaire was given to all participants addressing EC-associated symptoms, at the time of initial clinic visit. Odds ratios (ORs) were used to compare prevalence of symptoms between EC cases and controls. Logistic regression was used to determine the impact of menopausal status and obesity on symptom prevalence. RESULTS The cases (n = 75) were significantly older than the AV (n = 203) and PV (n = 151) controls (59.7 vs. 49.8 vs. 51.0 years, p < 0.01), had a higher body mass index (35.5 vs. 29.4 vs. 30.9 kg/m2, p < 0.01), and were more likely to be postmenopausal (76% vs. 53.7% vs. 52.0%, p < 0.01). The cases were more likely to report postmenopausal bleeding (OR = 32.99 and 5.83, p < 0.01) and abnormal vaginal discharge (OR = 8.8 and 3.3, p < 0.01) compared with the AV and PV groups. Overall, 55.4% of cases reported abnormal vaginal discharge. CONCLUSIONS Symptoms of both postmenopausal bleeding and abnormal vaginal discharge were significantly higher in EC compared with controls. The presence of such symptoms should raise concern for malignant disease and prompt immediate gynecological evaluation.
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Affiliation(s)
- Janelle B Pakish
- 1 Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M.D. Anderson Cancer Center , Houston, Texas
| | - Karen H Lu
- 1 Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M.D. Anderson Cancer Center , Houston, Texas
| | - Charlotte C Sun
- 1 Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M.D. Anderson Cancer Center , Houston, Texas
| | - Jennifer K Burzawa
- 1 Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M.D. Anderson Cancer Center , Houston, Texas
| | | | | | - Bryan Fellman
- 4 Department of Biostatistics, University of Texas M.D. Anderson Cancer Center , Houston, Texas
| | - Diana L Urbauer
- 4 Department of Biostatistics, University of Texas M.D. Anderson Cancer Center , Houston, Texas
| | - Pamela T Soliman
- 1 Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M.D. Anderson Cancer Center , Houston, Texas
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Elkholi DGE, Nagy HM. Unexplained postmenopausal uterine bleeding from atrophic endometrium: Histopathological and hormonal studies. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2015. [DOI: 10.1016/j.mefs.2015.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Mahmud A, Smith P, Clark J. The role of hysteroscopy in diagnosis of menstrual disorders. Best Pract Res Clin Obstet Gynaecol 2015; 29:898-907. [DOI: 10.1016/j.bpobgyn.2015.03.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 03/18/2015] [Indexed: 11/16/2022]
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