title: Role of postmenopausal bleeding pattern and women's age in the prediction of endometrial cancer.
abstract: BACKGROUND
  Women with postmenopausal bleeding should be evaluated efficiently to exclude endometrial carcinoma.
  
  
  OBJECTIVE
  To estimate the risk of endometrial cancer using individual case characteristics among women with postmenopausal bleeding in whom the endometrial thickness is >4 mm.
  
  
  METHODS
  Women with postmenopausal bleeding underwent clinical evaluation followed by transvaginal ultrasonography and endometrial biopsy. Clinical evaluation included age, body mass index, duration of menopause, number of bleeding episodes and amount of bleeding.
  
  
  RESULTS
  This study included 142 women, and endometrial carcinoma was found in 18 (12.7%). Older age, higher body mass index, longer duration of menopause, longer lasting bleeding episodes, higher amount of bleeding and recurrent bleeding episodes were the clinical characteristics associated with endometrial cancer. However, multivariate analysis revealed >55 years of age during postmenopausal bleeding, history of recurrent bleeding episodes and bleeding exceeding 5 pads per day in each episode as significant parameters, which predicted the presence of endometrial cancer among women with postmenopausal bleeding.
  
  
  CONCLUSIONS
  Prompt evaluation is required in women with postmenopausal bleeding to exclude endometrial cancer. Transvaginal ultrasonography is a reasonable first-line approach, and invasive sampling is required when ultrasonographic endometrial thickness is above 4 mm. However, about 90% of women with postmenopausal bleeding will finally be found to have a nonmalignant condition. Therefore, women who are at increased cancer risk should further be distinguished. This may be achieved using individual patient characteristics that result in a more accurate evaluation strategy with lower rates of unnecessary invasive procedures.
authors.affiliation: Department of Obstetrics and Gynaecology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors.forename: Mehmet C
authors.initials: MC
authors.lastname: Salman
authors.forename: Gurkan
authors.initials: G
authors.lastname: Bozdag
authors.forename: Selen
authors.initials: S
authors.lastname: Dogan
authors.forename: Kunter
authors.initials: K
authors.lastname: Yuce
mesh_terms: D041342:Absorbent Pads; D000367:Age Factors; D000368:Aged; D001706:Biopsy; D015992:Body Mass Index; D016889:Endometrial Neoplasms / Q000175:diagnosis*; D004717:Endometrium / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D008875:Middle Aged; D017698:Postmenopause; D011237:Predictive Value of Tests; D012008:Recurrence; D013997:Time Factors; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000000981:diagnostic imaging* / Q000473:pathology
keywords: age; bleeding pattern; endometrial cancer; endometrial sampling; postmenopausal bleeding