ABSTRACT
This study was conducted on 170 postmenopausal patients, their mean age, parity and weight were 58.7 +/- 5.4, 6.1 +/- 2.5 and 69.3 +/- 5.1 respectively. 158 [92.94%] of them had postmenopausal bleeding and or discharge which may be watery, serosanginous, purulent offensive or caseous. However 10 [5.9%] patients had pelviabdominal ovarian mass while2 [1.17%] patients had ulcer or mass in the vulva. Full history was taken, general, abdominal, local, bimanual examination was done, cervical and vaginal smear were taken by cytobrush and Colopscopic directed biopsy from suspicous area of the cervix was done. Full laboratory investigation was performed. Abdominal and vaginal Ultrasonography, CT scan, IVU and X-ray chest were done, fractional diagnostic curettage was done for all cases of post menopausal uterine bleeding and biopsy from vulval mass or ulcer was taken. Malignant ovarian tumors constitute 10 cases, 4 [2.34%], of them had papillary serous cystadenocarcinoma stage IC grade I and II, one [0.58%] case had malignant granulosa cell tumor stage Ic grade I, both type were treated by panhysterectomy total omentectomy, plevic and paraaortic Iymphadenectomy followed by four courses of [PAC] platinum, adriamycin and Cyclophosphamide 4 [2.34%] cases had papillary serous cystadenocarcinoma mucinous cystadenocarcinoma and endometrioid carcinoma stage IIIc grade III were treated by optimal debulking followed by six courses of PAC followed by recurrence in the pelvic colon with intestinal obstruction within 1.5 year from optimal debulking treated by resection with safty margin and colonic reanastomosis. One [0.58%] case had fibrosarcoma stage IIIc grade III treated by optimal debulking + Postoperative extended field abdominal and pelvic irradiation + multiple agent chemotherapy, followed by massive pelvic, intraperitoneal recurrence and distant pulmonary metastases and death after 6 month from optimal debulking. 127 [74.70%] patients had post menopausal uterine bleeding due to post menopausal uterine lesion presented as the following: 24 [14.1%] of them had atrophic endometrium and atrophic endometritis with severe menopausal symptoms treated by cyclic oestrogel and utrogestan for 6 month, 12 [7.05%] patients had proliferative endometrium treated symptomatically by cyclokapron/However hyperplastic proliferative endometrium and cystic glandular hyperplasia were present in 9 [5.29%] and 18 [10.58%] cases respectively and treated by cyclic provera tablet, for 3-6 month. While patients had atypical endometrial hyperplasia atypical endometrial hyperplasia with adenomyosis, hyperplastic proliferative endometrin with adenomyosis and uterine fibroid, cystic glandular hyperplasia with endometrial polyp and adenomyosis, proliferative endometrium with endometrial polyp and adenomyosis, secretory endometrium with adenomyosis, chronic endometritis with submucus fibroid and fibroid polyp and T.B. endometritis were present in 43 [25.29%] patients, all cases treated by panhysterectomy except the last one case treated by rimactazid and streptomycin. 21 [12.35%] patients had endometrial carcinoma, 17 of them had stage IA grade I and II and were treated by extrafascial hysterectomy + bilateral salpingo-oophorectomy + vaginal cuff, 3 [1.76%] patients had endometrial papillary serous carcinoma stage IIIC grade III were treated by panhysterectomy + bilateral salpingo-oophorectomy + omentectomy + pelvic and paraaortic irradiation + 6 courses of PAC chemotherapy, one [0.58%] case had carcinosarcoma stage IIIc grade III aged 70 year cachectic treated by panhysterectomy + external pelvic irradiation + PAC chemotherapy. 29 [17%] patients had postmenopausal cervical lesions, 18 [10.58%] of them had benign cervical polyp, 12 [7.05%] were cervical mucus polyp in which 4 of them had associated CIN II, however other 6 [3.52%] cases had endocervical fibroid polyp, all were treated by cervical polypecto my+ electrodiathermy cautery for CIN II. However 11[6.47%] patients had cervical carcinoma, 7 [4.11%] of them had non keratinizing squamous cell carcinoma stage IB-2A grade II, one [0.58%] case had endocervical adenocarcinoma stage 2A grade II, both were treated by Whertium radical hysterectomy + postoperative external pelvic irradiation, one [0.58%] case had stage IIIB grade III squamous cell carcinoma of the cervical stump treated by external pelvic irradiation + endovaginal irradiation, 2 [1.17%] cases had stage IVA grade III non eratinizing squamous cell carcinoma infiltrating the bladder were treated by anterior pelvic eccenteration + ileal condue. 2 [1.17%] patients had atrophic vaginitis and vaginal ulcers were treated by ovestin + utrogestan for 3-4 week. However 2 [1.17%] cases had stage II grade II squarnou5 cell carcinoma of the vulva were treated by radical vulvectomy + postoperative irradiation