title: Five-year follow-up of patients with recurrent postmenopausal bleeding.
abstract: BACKGROUND
  The most common symptom of endometrial cancer is postmenopausal bleeding. For women who present with postmenopausal bleeding and a benign tissue diagnosis, recurrent bleeding is a worrisome problem. We evaluated such patients to search for a model of good management.
  
  
  METHODS
  We studied women aged 50 years or over who presented with postmenopausal bleeding and underwent either dilatation and curettage (D & C) or endometrial biopsy from 1990 to 1991 at Long Island Jewish Medical Center, New Hyde Park, NY, USA. The selected patients were monitored for 5 years, until 1996. For those who had an initial benign tissue diagnosis and presented with recurrent postmenopausal bleeding in the following 5 years, we studied the differences in histologic diagnoses.
  
  
  RESULTS
  Seventy-seven patients had an initial benign tissue diagnosis of postmenopausal bleeding followed by recurrent bleeding. After repeat D & C or endometrial biopsy (2-6 times), 16 patients (20.8%) had endometrial cancer or endometrial complex hyperplasia. Of the 12 patients who had two or more benign tissue diagnoses, seven (58.3%) had tumors found in subsequent surgery. The diagnoses included endometrial cancer, ovarian cancer, cervical cancer and benign tumor. Postmenopausal women aged 65 years or over had a much greater chance (13/29, 44.8%) of having endometrial cancer or complex hyperplasia than women aged below 65 years (6/48, 12.5%) who presented with recurrent postmenopausal bleeding and had an initial benign tissue diagnosis (c2 = 7.893, p = 0.0050).
  
  
  CONCLUSIONS
  Although the initial tissue diagnosis might be benign, the possibility of endometrial cancer or complex hyperplasia cannot be ruled out for women with recurrent postmenopausal bleeding. Diagnostic D & C or endometrial biopsy combined with other tools (vaginal ultrasound, hysteroscopy, transvaginal sonohysterography) are more reliable for evaluating women with recurrent postmenopausal bleeding than D & C or endometrial biopsy only. If these diagnostic results are negative, a total hysterectomy with bilateral salpingo-oophorectomy should be considered to reduce the risk of endometrial cancer in women who present with recurrent bleeding.
authors.affiliation: Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taiwan, ROC.
authors.forename: N F
authors.initials: NF
authors.lastname: Twu
authors.forename: S S
authors.initials: SS
authors.lastname: Chen
mesh_terms: D000367:Age Factors; D001706:Biopsy; D002675:Child, Preschool; D004107:Dilatation and Curettage; D016889:Endometrial Neoplasms / Q000175:diagnosis; D004717:Endometrium / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D012008:Recurrence; D014592:Uterine Hemorrhage / Q000209:etiology*