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Dr Nayab Mohiuddin
Dr. Uzma Shabab
Dr. Qurat Ul Aman Siddiqui
Dr. Nudrat Tanveer


Endometrial cancer, post-menopausal bleeding, hysteroscopy, incidence


Background and Aim: Endometrial carcinoma (EC) is the most common cancer among women in developed countries, accounting for approximately five percent of all cancer cases and exhibiting a global morbidity rate of up to 2% in women. The present study aimed to determine the frequency of endometrial cancer in women with postmenopausal bleeding (PMB) on hysteroscopic guided dilatation and curettage at a tertiary care hospital in Karachi.


Patients and Methods: A descriptive cross-sectional study was carried out on 149 post-menopausal bleeding patients in the Obstetrics and Gynecology Department at Liaquat National Hospital, Karachi. Patients (age >45 years) with postmenopausal bleeding who underwent hysteroscopy guided dilatation and curettage were enrolled. Patient age, past medical and gynecological history, medical records, and endometrial thickness on ultrasound, pathology, and diagnosis were recorded. SPSS version 22 was used for descriptive statistics.


Results: The overall mean age of patients was 56.28±8.46 years. Patients were distributed based on their age groups as follows; 44 (29.5%) in 45-55 years, 86 (57.7%) 56-65 years, and 19 (12.8%) >65 years. Majority of patients 112 (75.2%) belonged to rural areas and 88 (59.1%) were illiterate. The incidence of nulliparous and multiparous was 43% (n=64) and 57% (n=85) respectively. Of the total 149 PMB cases, the incidence of malignancy was 20.1% (n=30). Benign endometrial polyps was the most prevalent 56 (37.6%) histopathological findings on hysteroscopy followed by uterine cancer (polypoidal growth) 30 (20.1%), simple hyperplasia and cystic hyperplasia 28 (18.8%), hyperplasia with atypia 19 (12.8%), normal-proliferative endometrium 9 (6%), and benign endocervical polyps 7 (4.7%). Out of 30 polypoidal growth cases, the incidence of endometrial adenocarcinoma, endocervical carcinoma, and uterine sarcoma (large polypoidal growths) was 22 (73.3%), 3 (10%), and 5 (16.7%) respectively.


Conclusion: The present study found that the incidence of malignancy was 20.1% in PMB women. The gold standard protocol for PMB cases consists of hysteroscopy-guided curettage with subsequent histopathological examination.


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