Issue 3/2024
Dimitrov, O., Kasemiar, T.
PSAGBAL „St. Sofia“ – Sofia
A woman is labeled menopausal if she has gone twelve months without menses. After a woman is postmenopausal, further vaginal bleeding is no longer considered normal. The differential diagnosis of postmenopausal bleeding includes many benign and malignant conditions, the most common of which is atrophy, but the most concerning possible etiology is endometrial cancer. About 1-14% of postmenopausal bleeding will be secondary to endometrial cancer (1). As with most malignancies, early diagnosis may lead to a better prognosis. Therefore, a postmenopausal woman with vaginal bleeding should be promptly and appropriately evaluated. For the past decade, transvaginal ultrasound (TVUS) has become an extensively used investigative tool in the work-up of several gynecologic problems. Moreover, some asymptomatic postmenopausal women undergo TVUS as part of routine gynecologic assessment. However, the widespread use of ultrasound has also identified a subset of postmenopausal patients who have a finding of a thickened endometrium on ultrasound, but who do not have bleeding. There is considerable variability in the endometrial thickness and the likelihood of endometrial carcinoma across women. This variability has been associated with individual patient characteristics including age, time since menopause, obesity, hypertension, diabetes mellitus, and reproductive factors [23,32–36]. However, guidelines currently used are mainly based on endometrial thickness only, and do not systematically take these additional characteristics into account.
Address for correspondence:
Dimitrov, O.
1st Specialized Hospital in Obstetrics and
Gynecology „Saint Sofia
2, „Mihalaki Tashev“ Str.,
housing complex „Krasna Polyana“
1330, Sofia