Hysteroscopic Evaluation of Postmenopausal Bleeding

Khalidah Mohammed Amin
In: Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) · 2025 · vol. 9(2) , pp. 97–102 · doi:10.54133/ajms.v9i2.2360 · W4414882099
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This cross-sectional study evaluated the role of diagnostic hysteroscopy in 80 women with symptomatic ongoing postmenopausal bleeding, correlating hysteroscopic visual findings with histopathology based on questionnaires, hysteroscopy, and tissue examination. Hysteroscopy detected abnormalities in 97.5% of cases, while histopathology confirmed abnormal findings including endometrial polyps (36.3%), hyperplasia (18.7%), submucous fibroids (16.3%), atrophic endometrium (15%), and endometrial adenocarcinoma (10%), with increased age significantly associated with malignant lesions (p<0.001). Reported diagnostic accuracies were very high for polyps, submucous myoma, atrophic endometrium, and irregular growth, but lower for polypoidal endometrium (71.2%), and the paper’s design is limited by its relatively small, referred sample without stated randomization or blinding. Relevance to endometriosis: the paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

Background: Postmenopausal bleeding (PMB) is a common gynecological condition presented to national health institutes, and assessing the exact reason for postmenopausal bleeding is essential to detect the emergency status and to plan appropriately for management. For that, diagnostic technology is crucial in PMB. Hysteroscopy has proven to be a useful tool in visualizing and identifying common causes of PMB. Objective: To evaluate the role of hysteroscopy in identifying the most common causes of PMB and correlate clinically with histopathological findings. Methods: A cross-sectional study was conducted in the period from March 1, 2019, to February 28, 2025, involving 80 women with symptomatic ongoing postmenopausal bleeding who had been referred to hysteroscopy. Information was gathered from patient-based questionnaires, in addition to hysteroscopy and histopathology findings. Results: Most women were aged 50–59 years (51.2%), had a parity of ≥5 (62.5%), were overweight or obese (86.3%), and had been menopausal for ≤10 years (51.2%). Hysteroscopy detected abnormalities in 97.5% of cases. Histopathology confirmed abnormal findings comprising polyps (36.3%), hyperplasia (18.7%), submucous fibroids (16.3%), atrophic endometrium (15%), and endometrial adenocarcinoma (10%). Increased age was significantly associated with malignant lesions (p<0.001). Hysteroscopy showed high diagnostic accuracy for endometrial polyps (98.7%), submucous myoma (100%), atrophic endometrium (93.7%), and irregular growth (97.5%), but lower accuracy for polypoidal endometrium (71.2%). Conclusions: Hysteroscopy is a reliable and useful tool in visualizing the causes of postmenopausal bleeding and has shown that endometrial polyps are the most common cause of PMB.
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Background

Postmenopausal bleeding (PMB) is a common gynecological condition presented to national health institutes, and assessing the exact reason for postmenopausal bleeding is essential to detect the emergency status and to plan appropriately for management. For that, diagnostic technology is crucial in PMB. Hysteroscopy has proven to be a useful tool in visualizing and identifying common causes of PMB. Objective: To evaluate the role of hysteroscopy in identifying the most common causes of PMB and correlate clinically with histopathological findings. Methods: A cross-sectional study was conducted in the period from March 1, 2019, to February 28, 2025, involving 80 women with symptomatic ongoing postmenopausal bleeding who had been referred to hysteroscopy. Information was gathered from patient-based questionnaires, in addition to hysteroscopy and histopathology findings. Results: Most women were aged 50–59 years (51.2%), had a parity of ≥5 (62.5%), were overweight or obese (86.3%), and had been menopausal for ≤10 years (51.2%). Hysteroscopy detected abnormalities in 97.5% of cases. Histopathology confirmed abnormal findings comprising polyps (36.3%), hyperplasia (18.7%), submucous fibroids (16.3%), atrophic endometrium (15%), and endometrial adenocarcinoma (10%). Increased age was significantly associated with malignant lesions (p<0.001). Hysteroscopy showed high diagnostic accuracy for endometrial polyps (98.7%), submucous myoma (100%), atrophic endometrium (93.7%), and irregular growth (97.5%), but lower accuracy for polypoidal endometrium (71.2%). Conclusions: Hysteroscopy is a reliable and useful tool in visualizing the causes of postmenopausal bleeding and has shown that endometrial polyps are the most common cause of PMB. Downloads

References

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DOI: https://doi.org/10.47750/jptcp.2022.954 Downloads Published How to Cite Issue Section License Copyright (c) 2025 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Published by Al-Rafidain University College. This is an open access journal issued under the CC BY-NC-SA 4.0 license (https://creativecommons.org/licenses/by-nc-sa/4.0/).

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