Postmenopausal vaginal bleeding in women using hormone replacement therapy

Burbos, Nikolaos; Musonda, Patrick; Duncan, Timothy J.; Crocker, Simon G.; Nieto, Joaquín J.; Morris, Edward

doi:10.1258/mi.2011.011111

Cited by 23 publications

(24 citation statements)

References 20 publications

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“…16,17 Even though, PMB is commonly associated with endometrial polyps or/and might result from spontaneous bleeding in women treating with hormone therapy. 18 In some studies, the risks of developing endometrial cancer in females with post menopausal bleeding vary widely from 3% to 25%. 19,20 Most endometrial cancer is diagnosed at a localized stage and is usually treatable with surgery, with a -year survival rate of about 95%.…”

Section: Introductionmentioning

confidence: 99%

Risk factors associated with postmenopausal bleeding and endometrial carcinoma.

Bukhari

Qazi

Jahan

et al. 2021

TPMJ

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Objective: The objectives of the study were to identify the common causes of post menopausal bleeding, benign and malignant causes of post menopausal bleeding and also the identification of risk factors for endometrial carcinoma in women with postmenopausal bleeding. Study Design: Cross sectional survey. Setting: Fauji Foundation Hospital Rawalpindi. Period: August 2018 to January 2019. Material & Methods: A total of 224 women with post menopausal bleeding were included in this study. Data was collected through the self structured questionnaire in which we have included patient’s demographics, risk factors of Post menopausal bleeding and risk factors of endometrial carcinoma. Histopathological investigations of endometrial sampling were done for identification of benign and malignant causes of post menopausal bleeding. Results: Mean age of the women was 59.17 years and mean parity was found to be 2.24. Out of 224 patients 106(47.3%) women had their menopause in duration of 6 to 10 years while 75(33.9%) had menopause in time duration of first 5 years showing high frequency trend of post menopausal bleeding in first ten years duration after menopause. Out of 224 patients 30(13.4) were of normal weight, 94(42.0) were overweight while 100(44.6) were obese according to BMI criteria. Endometrial carcinoma was found in 40 women with post menopausal bleeding. Among them age at menarche was found to be 9 to 13 years in 27(67.5%) patients while more than 13 years in 13(32.5%) women. Age at menopause was found more than 55 years in 20(50%) patients while less than 55 years also in 20(50%) patients. Personal history of breast carcinoma was reported in 6(15%) similarly family history was also found in 6(15%) women. Family history of CA endometrium was observed in 3(7.5%). History of PCOs was also observed in 5(12.5) patients. Menstrual irreguraity in perimenopausal period was found in 18(45%) patients with endometrial CA. Nulliparity was reported in 21(52.5%) patients. 12(30%) were on estrogen use while 4(10%) were on Tamoxifen use. Conclusion: Diabetes Mellitus and Hypertension were observed as common risk factors for post menopausal bleeding. Endometrial Carcinoma, cervix carcinoma and Hyperplasia with atypia were common malignant causes while endometrial polyp and fibroid uterus were commonly found benign causes of post menopausal bleeding. Early menarche, menopausal duration of more than one year, obesity and diabetes mellitus were common risk factors for endometrial carcinoma.

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Section: Introductionmentioning

confidence: 99%

Risk factors associated with postmenopausal bleeding and endometrial carcinoma.

Bukhari

Qazi

Jahan

et al. 2021

TPMJ

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“…14 In women on HRT, this risk is lower as reported in previous studies. In a study by Burbos et al., 3 4847 post-menopausal women with bleeding were investigated with an endometrial biopsy, including 750 (15%) women on HRT. The study found that women using HRT preparations were significantly less likely to be diagnosed with endometrial cancer (p < 0.001).…”

Section: Discussionmentioning

confidence: 99%

“…1 Sequential HRT (seq-HRT) gives up to 90% of women a cyclical bleed whereas women on continuous combined HRT (con-HRT) preparations are expected to be amenorrhoeic due to endometrial atrophy. 2,3 Unscheduled bleeding is defined as abnormal bleeding on seq- or con-HRT six months post initiation of therapy or after a period of amenorrhoea. 4 An initial phase of irregular bleeding is common in women in the first six months of treatment 2 while persistent bleeding after this period of treatment should always be investigated.…”

Section: Introductionmentioning

confidence: 99%

“…4 An initial phase of irregular bleeding is common in women in the first six months of treatment 2 while persistent bleeding after this period of treatment should always be investigated. 3 A change in bleeding pattern including heavy and/or painful bleeding or change in the timing of the withdrawal bleed should also be investigated. 5 The National Institute for Health and Care Excellence directs healthcare professionals to advise women to report unscheduled vaginal bleeding at the three-month review appointment or promptly if it occurs after the first three months.…”

Section: Introductionmentioning

confidence: 99%

“…In women who present with post-menopausal bleeding, a normal EMT has been agreed at a cut-off of <4 mm on TVUS. 1–13 In our unit, an outpatient endometrial biopsy is obtained at an EMT ≥5 mm in women with unscheduled bleeding on HRT in line with the The British Gynaecological Cancer Society Uterine Cancer guideline. 14 A careful assessment of the morphology of the endometrium and the timing of a withdrawal bleed is made in those patients on seq-HRT.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of endometrial assessment in women with unscheduled bleeding on hormone replacement therapy

Idle

Hamoda

2019

Post Reprod Health

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This study correlates the transvaginal ultrasound findings with histopathology results in women who present with unscheduled bleeding on hormone replacement therapy. Study design: Retrospective analysis of 469 consecutive cases with unscheduled bleeding on hormone replacement therapy (203 patients on sequential hormone replacement therapy (seq-HRT) and 266 patients on continuous combined hormone replacement therapy (con-HRT)). Main outcome measures: Outcomes of endometrial assessment in women with unscheduled bleeding on hormone replacement therapy. Results: Normal appearance of the endometrium on pelvic ultrasound was seen in 62% patients on seq-HRT and 43% of women on con-HRT. These women required no further assessment and were discharged. Histological assessment showed normal endometrial tissue in 22% of women on seq-HRT and 22% of con-HRT group. Benign endometrial polyps were noted in 8% of women on seq-HRT versus 18% of women on con-HRT. Hyperplasia without atypia was noted in 0.5% of woman on seq-HRT versus 0.4% of women on con-HRT while atypical hyperplasia/endometrial cancer was noted in 2% of women on seq-HRT versus 1% of women on con-HRT. Conclusion: Women who present with unscheduled bleeding on hormone replacement therapy both on sequential and continuous combined regimens can be reassured that the risk of pathology is low.

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Association of Endometrial Cancer Risk With Postmenopausal Bleeding in Women

et al. 2018

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IMPORTANCE As the worldwide burden of endometrial cancer continues to rise, interest is growing in the evaluation of early detection and prevention strategies among women at increased risk. Focusing efforts on women with postmenopausal bleeding (PMB), a common symptom of endometrial cancer, may be a useful strategy; however, PMB is not specific for endometrial cancer and is often caused by benign conditions. OBJECTIVE To provide a reference of the prevalence of PMB in endometrial cancers and the risk of endometrial cancer in women with PMB.

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Postmenopausal vaginal bleeding in women using hormone replacement therapy

Abstract: Postmenopausal women presenting with vaginal bleeding and using combined HRT preparations have significantly lower risk of being diagnosed with endometrial cancer when compared with women not using HRT.

Cited by 23 publications

References 20 publications

Risk factors associated with postmenopausal bleeding and endometrial carcinoma.

Risk factors associated with postmenopausal bleeding and endometrial carcinoma.

Outcomes of endometrial assessment in women with unscheduled bleeding on hormone replacement therapy

Association of Endometrial Cancer Risk With Postmenopausal Bleeding in Women

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