Outcome of investigations for postmenopausal vaginal bleeding in women under the age of 50 years

ObjectiveThe objective of this study is to determine the incidence of endometrial cancer in young postmenopausal women presenting with vaginal bleeding.MethodsCross-sectional study of postmenopausal women presenting with vaginal bleeding in a gynaecological oncology centre in the United Kingdom. All women underwent transvaginal ultrasound scanning (TVS) as the initial investigation tool to evaluate the endometrium. Endometrial biopsy was performed only in cases where endometrial thickness measured equal to or greater than 5 mm. The patients were divided into two groups based on their age: less than 50 years (Group A) and 50 years or older (Group B).ResultsOver a 57-month period, 4454 women were investigated for postmenopausal vaginal bleeding. Of these, 259 (5.8%) women were diagnosed with endometrial carcinoma. 260 (5.8%) women were younger than 50 years. Endometrial biopsy was not performed in 130 women in Group A that had an endometrial thickness measurement of less than 5 mm on ultrasonography. With a median follow-up period of 3 (1–5) years, we found no cases of endometrial cancer in women under the age of 50 that did not undergo endometrial biopsy at the time of initial evaluation. Overall, no cases of endometrial cancer were diagnosed in postmenopausal women under the age of 50 years.ConclusionsWe found no cases of endometrial cancer amongst 260 women presenting with postmenopausal vaginal bleeding under the age of 50 years. These women could be investigated on a less urgent basis depending on the available resources.

► Of women presenting with postmenopausal vaginal bleeding, 5.8% were younger than 50 years.
► We found no cases of endometrial cancer were found in young postmenopausal women.
► Endometrial pathology was less likely in women younger than 50 years.