Unexpected malignancy in perimenopausal versus postmenopausal uterine bleeding

In this study, a total of 600 cases of irregular uterine bleeding in the age group 40-60 years were chosen. Full dilatation and endometrial curettings was done in every patient and the biopsy obtained was subjected to histopathological examination. Out of the 600 patients studied, 515 [85.8%] were perimenopausal and 85 [14.2%] were postmenopausal. The incidence of malignancy was 6.5%. The highest incidence was coporal malignancy with a peak at the age group 55-59 years followed by cervical malignancy with a peak at the age group 40-49 years. The incidence of malignancy in age group 40-44 was 2% and it increased tremendously with age representing 68.4% of cases of uterine bleeding at the age group 55-59 and 87.5% at the age of 60. Premalignant lesions represented 81.5% of cases. Cystic hyperplasia and simple hyperplasia with or without atypia represented 56.7% and affected mostly women of the age group 40-44 years. Disorders of pregnancy represented 7.8% of cases, while atrophic endometritis accounted for 4.2% of causes of uterine bleeding. Thus, the relatively high incidence of malignancy in peri and postmenopausal bleeding justified the employment of dilatation and full curettings as a definite diagnostic method to exclude malignancy