title: Recurrent postmenopausal bleeding: a prospective cohort study.
abstract: OBJECTIVE
  To estimate the prevalence of genital tract diseases in women with initial and recurrent postmenopausal bleeding (PMB) to help inform diagnostic pathways.
  
  
  METHODS
  Prospective cohort study (Canadian Task Force classification: II-2).
  
  
  METHODS
  Large urban teaching hospital.
  
  
  METHODS
  Of 1938 consecutive women with postmenopausal bleeding, 106 (5%) were investigated for a recurrent episode after having normal findings of previous investigations.
  
  
  METHODS
  All women underwent pelvic examination and ultrasound scanning. An endometrial biopsy was performed when endometrial thickness was >4 mm in women with a first episode of PMB, with recourse to outpatient hysteroscopy after correlation between clinical and pathologic findings. All women with a recurrent PMB episode underwent endometrial biopsy and outpatient hysteroscopy.
  
  
  RESULTS
  The risk of having endometrial cancer or hyperplasia with atypia was significantly less in women with recurrent PMB (9%) as compared with those with a first episode of PMB (8%) (p = .002), but were significantly more likely to have benign endometrial polyps (28%) compared with women with a first episode of PMB (19%) (relative risk, 1.47; 95% confidence interval, 1.07-2.02; p = .02).
  
  
  CONCLUSIONS
  Recurrent PMB results in less likelihood of premalignant and malignant endometrial disease; however, in 1 of 4 women PMB is caused by endometrial polyps. First-line investigation in women with recurrent PMB should be tests that have high accuracy for enabling diagnosis of focal diseases, such as outpatient hysteroscopy or saline infusion sonography.
authors.affiliation: Birmingham Women's Hospital, Birmingham, United Kingdom. Electronic address: paul.smith@doctors.net.uk.
authors.forename: Paul P
authors.initials: PP
authors.lastname: Smith
authors.affiliation: Birmingham Women's Hospital, Birmingham, United Kingdom.
authors.forename: Siobhan
authors.initials: S
authors.lastname: O'Connor
authors.affiliation: Birmingham Women's Hospital, Birmingham, United Kingdom.
authors.forename: Janesh
authors.initials: J
authors.lastname: Gupta
authors.affiliation: Birmingham Women's Hospital, Birmingham, United Kingdom.
authors.forename: T Justin
authors.initials: TJ
authors.lastname: Clark
mesh_terms: D001706:Biopsy; D015331:Cohort Studies; D055088:Early Detection of Cancer; D016889:Endometrial Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D004717:Endometrium / Q000473:pathology*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D015907:Hysteroscopy; D008875:Middle Aged; D010045:Outpatients; D011127:Polyps / Q000473:pathology*; D017698:Postmenopause; D011230:Precancerous Conditions / Q000473:pathology*; D015995:Prevalence; D011446:Prospective Studies; D014505:Urban Population; D014592:Uterine Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D014594:Uterine Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology
keywords: Endometrial cancer; Hysteroscopy; Polyps; Postmenopausal bleeding