The Pattern of Histo-Pathological Diagnosis in Sudanese Women with Postmenopausal Bleeding
Journal of Women's Health Care

Journal of Women's Health Care
Open Access

ISSN: 2167-0420


Short Communication - (2016) Volume 5, Issue 5

The Pattern of Histo-Pathological Diagnosis in Sudanese Women with Postmenopausal Bleeding

Yassin K1, Fagear AA2, Hussein S3 and Ali AAA4*
1Department of Obstetrics and Gynaecology, Faculty of Medicine, Alneelain University, Khartoum, Sudan
2Department of Obstetrics and Gynaecology, Faculty of Medicine, Khartoum University, Khartoum, Sudan
3Department of Obstetrics and Gynaecology, Faculty of Medicine, Bahri University, Khartoum, Sudan
4Department of Obstetrics and Gynaecology, Faculty of Medicine, Kassala University, Kassala, Sudan
*Corresponding Author: Ali AAA, Department of Obstetrics and Gynaecology, Faculty of Medicine, Kassala University, Kassala, Sudan, Tel: 249912351175 Email:

Keywords: Menopause; Bleeding; Endometrium; Cancer; Histopathology


The World Health Organization (WHO) estimates that by the year 2030 approximately 1.2 billion of women will be aged over 50 years [1,2]. As a result of this fact, the programme managers and researchers are invited to the health needs of women in menopause incorporated as an essential item in health research and public health programs. The aim of this study was to investigate the histopathological pattern and risk of malignancy among women presented with postmenopausal bleeding (PMB) at Omdurman Maternity Hospital, Sudan. Data was collected prospectively from 140 patients with PMB during the period of 1st January 2015-31st December 2015 and we excluded those with premature menopause whether surgical or natural, age less than 50 years and patients on hormone replacement therapy.

Clinical details of the patients were obtained; Figure 1 showed the clinical approach to the investigated patients.


Figure 1: Diagnostic approach to postmenopausal bleeding.

The endometrial curettage and cervical biopsy material was immediately fixed in 10% fresh formalin. The tissue pieces were processed routinely and were stained with haematoxylin and eosin and the histological findings were noted. All the included women were evaluated clinically by Gynaecologist and Transvaginal (HDI 5000 or HDI-Ultra mark) Ultrasound was performed by expert to evaluate the endometrial thickness.

The different variables were compared between the different groups of women based on the histopathological pattern and P<0.05 was considered significant. The study received ethical clearance from the Sudan Medical Specialization Board SMSB), Department of Obstetrics and Gynaecology.

During the study period a total of 140 patients with PMB were enrolled. Their age ranged between 50-64 year with mean (SD) 58.6(6.3). Their mean (SD) parity and BMI was 7.6(2.7) and 26.9(5.7) respectively. The majorities were married (102, 72.8%) of less than secondary education (92, 65.7%), and of urban residence (127, 90.7%).

Of the total respondents 43(30.7%), 19(13.5%), 45(32.1%), 20(14.2%) and 3(2.1%) gave history of PMB, diabetes mellitus, hypertension, hypothyroidism and active smoking respectively. Only 1(0.7%) woman had history of cervical smear. With regard to findings of speculum examination, 115(82.1%) of women had normal cervical appearance and 25(17.9%) women had abnormal cervical appearance. Based on TVS; 79(56.4%) women had endometrial thickness of 5 mm and more while 61(43.6%) women had endometrial thickness of less than 5 mm.

The histopathological results for women who presented with postmenopausal bleeding was broad. Most of the women with PMB have benign disease. Benign, precancerous and malignant conditions was found in 87(62.2%), 10(7.1%) and 43(30.7%) women respectively. The histopathological appearance of the 140 women with PMB was as follow:

Endometrial polyp 30(21.4%), Atrophic endometrium 25(17.8%), Endometrial cancer 23(16.4%), Normal endometrium 21(15%), Cervical cancer 20(14.3%), Endometrial hyperplasia with or without atypia 13(9.3%), Chronic endometritis 4(2.9%) and insufficient for diagnosis 4(2.9%).

Obese patients (BMI=31.5(3.8)) and those who have history of postmenopausal bleeding were significantly had higher incidence of endometrial cancer. In this study the endometrial cancer was observed in women with advanced age (68 ± 7.2 year).

In this study benign causes were most frequent than malignant causes for PMB. However endometrial and cervical cancers were reported in 16.43% and 14.29% of the investigated women respectively (Table 1).

Variable Normal Endometrium (N=21) Endometrial Cancer (N=23) Cervical Cancer (N=20) P
Age 58.6 (6.7) 68.3 (7.2) 57.3 (6.9) 0.01
Parity 6.3 (3.3) 6.5 (2.9) 6.1 (3.2) 0.251
BMI 22.3 (4.4) 31.5 (3.8) 22 (3.1) 0.002
Urban residence 20(95.2%) 22(95.6%) 18 (90%) 0.51
Smoking, yes 1 (4.7%) 2 (8.6%) 0 (00) 0.621
Diabetes Mellitus 6(28.3%) 7(30.4%) 5 (25%) 0.534
PMB 1 (4.7%) 10 (43.4%) 3 (15%) 0.533

Table 1: Comparison between normal and malignant histopathological findings in Sudanese women presented with postmenopausal bleeding. (BMI: Body mass index, PMB: postmenopausal bleeding). Data is shown as mean (SD) and number (%) as applicable.

The health of menopausal women is a very big concern in the community and many studies were conducted in this field [3-5].

Postmenopausal bleeding is alarming sign that may be associated with cervical or uterine malignancy. Postmenopausal uterine bleeding is etiologically associated with endometrial cancer in 10 to 30% of cases [6]. In the present study the endometrial cancer was observed with advanced age (mean ± SD 68.3 ± 7.2 year). In agreement with our results an increasing incidence of endometrial malignancy in advanced aged and obese women has been demonstrated before [7].

Our results showed high incidence rate of cervical cancer and almost all of our patients have no history of cervical screening. Cervical cancer is largely preventable by effective screening programs and considerable reduction in cervical cancer incidence and deaths has been achieved in developed nation with systemic cytology screening program [8,9]. These programs have not been possible to be organized in most low resource setting [10].

In conclusion high incidence of endometrial and cervical cancer was reported among Sudanese women presented with PMB. Although the discussions about endometrial screening in menopause is controversial, it might be of great benefit if screening programme is adopted using endometrial biopsy in particular among high risk patients [11,12].


  1. Shaw LM, Shaw SL (2009) Menopuse, evolution and changing cultures. Menopuse Int. 15: 175-179.
  2. Hanegem NV (2011) Diagnostic evaluation of the endometrium in postmenopausal bleeding: an evidence based approach. Maturitas 68: 155-164.
  3. Ciccone MM, Scicchitano P, Gesualdo M, Fornarelli F, Pinto V, et al. (2013) Systemic vascular hemodynamic changes due to 17-β-estradiol intranasal administration. J Cardiovasc Pharmacol Ther 18: 354-358.
  4. Ciccone MM, Scicchitano P, Cortese F, Gesualdo M, Zito A, et al. (2013) Modulation of vascular tone control under isometric muscular stress: role of estrogen receptors. Vascul Pharmacol 58: 127-133.
  5. Ciccone MM, Cicinelli E, Giovanni A, Scicchitano P, Gesualdo M, et al. (2012) Ophthalmic artery vasodilation after intranasal estradiol use in postmenopausal women. J Atheroscler Thromb 19: 1061-1065.
  6. Izetbegovic S, Stojkanovic G, Ribic N, Mehmedbasic E (2013) Features of postmenopausal uterine haemorrhage. Med Arh 67: 431-434.
  7. Chen LM, et al. (2012) Endometrial carcinoma: Epidemiology and risk factors.
  8. Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics 2002. CA Cancer J Clin 55: 74-108.
  9. Ecert L (2009) WHO position on cervical cancer prevention in developing countries. HPV Today 19: 7.
  10. Kaur M, Singh R, Sharma M (2010) Endovaginal sonographic evaluation of postmenopausal uterine bleeding. J Clin Diag Res 4: 2175-2182.
  11. Bindman RS, Weiss E, Feldstein V (2004) How thick is too thick? When endometrial thickness should prompt biopsy in postmenopausal women without vaginal bleeding. Ultrasound Obstet Gynecol 24: 558-565.
  12. Seebacher V, Schmid M, Polterauer S, Frischmuth KH, Leipold H, et al. (2009) The presence of postmenopausal bleeding as prognostic parameter in patients with endometrial cancer: a retrospective multi-center study. BMC Cancer 9: 460.
Citation: Yassin K, Fagear AA, Hussein S, Ali AAA (2016) The Pattern of Histo-Pathological Diagnosis in Sudanese Women with Postmenopausal Bleeding. J Women's Health Care 5:334.

Copyright: © Ali AAA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.