title: Investigations for postmenopausal uterine bleeding: special considerations for endometrial volume.
abstract: BACKGROUND
  Postmenopausal bleeding is a clinically important complaint in general gynecologic practice. The incidence of spontaneous postmenopausal bleeding in the general population is approximately 10 % immediately after menopause, and 5 % in all menopausal women.
  
  
  OBJECTIVE
  The study was aimed to reveal the histopathologic diagnosis of postmenopausal uterine bleeding, and to investigate the correlation between various clinical factors and endometrial carcinoma. We also evaluated the role of endometrial volume calculation in the clinical use for the endometrial histopathologic findings.
  
  
  METHODS
  In this prospective observational study, we recruited 163 postmenopausal women with abnormal uterine bleeding from January 2008 through December 2010. Women who had hematologic disease, or had nonuterine pelvic diseases were excluded. Clinical characteristics such as age, body mass index (BMI), associated diseases, and previous postmenopausal hormone therapy were checked. They were evaluated by transvaginal ultrasonography and underwent endometrial biopsy for the endometrial histopathologic examination.
  
  
  RESULTS
  Among the endometrial histopathologic findings, atrophic endometrium was the most common finding (32.7 %), followed by hyperplastic endometrium (10.4 %), endometrial carcinoma (10.4 %), and endometrial polyp (9.2 %). The prevalence of endometrial hyperplasia and cancer was not significantly different at the 5 mm cut-off thickness of the endometrium, but significantly higher in women with ≥ 3 mL of endometrial volume. However, the incidence of endometrial cancer and hyperplasia in women with endometrial bleeding was not significantly different with or without previous or current hormone therapy.
  
  
  CONCLUSIONS
  Endometrial biopsy should be performed to exclude endometrial hyperplasia and carcinoma in postmenopausal women with endometrial bleeding to perform proper and prompt treatment, especially in old aged women (> 60 years) and in patients with endometrial volume ≥ 3 mL.
authors.affiliation: Department of Obstetrics and Gynecology, Institute of Wonkwang Medical Science, College of Medicine, Wonkwang University, Iksan, Korea. hykyale@yahoo.com.
authors.forename: Hae Joong
authors.initials: HJ
authors.lastname: Cho
authors.forename: Eun Sil
authors.initials: ES
authors.lastname: Lee
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Lee
authors.forename: Seong Nam
authors.initials: SN
authors.lastname: Hong
authors.forename: Yong-Il
authors.initials: YI
authors.lastname: Ji
authors.forename: Heung Yeol
authors.initials: HY
authors.lastname: Kim
authors.forename: Ari
authors.initials: A
authors.lastname: Kim
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000473:pathology*; D000368:Aged; D001284:Atrophy / Q000150:complications / Q000473:pathology; D001706:Biopsy; D015992:Body Mass Index; D016889:Endometrial Neoplasms / Q000150:complications / Q000473:pathology*; D004717:Endometrium / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D006965:Hyperplasia / Q000150:complications / Q000473:pathology; D008875:Middle Aged; D009929:Organ Size; D011127:Polyps / Q000150:complications / Q000473:pathology*; D017698:Postmenopause; D011446:Prospective Studies; D013997:Time Factors; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000209:etiology*