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A HOSPITAL BASED STUDY ON POSTMENOPAUSAL BLEEDING
ABSTRACT
Objectives:To study the different sociodemographic factors related to postmenopausal
bleeding.
Methods: A detailed, precoded, pre-tested, structured, closed questionnaire was used to
collect the data. By interviewing these women, information was collected about different
demographic factors like age, socioeconomic status, parity etc The collected data was put in the
master chart and analyzed.
Settings: Department of Obstetrics & Gynecology, Pt. J. N. M. Medical college & DR. B. R.
Ambedkar Memorial , Hospital, Raipur(C. G.)
Study design: Hospital based cross sectional.
Participants: 146 postmenopausal women.
Statistical Analysis: Percentages, standard deviation.
Results The incidence of cases of postmenopausal bleeding was 3.5% .Maximum cases with
postmenopausal bleeding were found in the age group of 45-54yrs (50%). 60 % of total cases
came from rural areas. 62% of the patients were illiterate. 65% of the patients were grand
multipara (Parity 4). Most of the patients belonged to lower socioeconomic strata.
Conclusions
The bleeding is high, requiring immediate investigation of this symptom. With increasing life
span, the incidence of aggressive cancers is expected to increase. Hence it is imperative to
maintain a high index of suspicion even in our country and evaluate postmenopausal bleeding
thoroughly.This conclusion is not based on the findings of this study and there fore should be
avoided. There in a need for increasing awareness about the importance of postmenopausal
bleeding.The main findings are missing from abstract.
Key words: Postmenopausal bleeding, Incidence Key word should be changed .
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INTRODUCTION
A woman is considered menopausal after 12 months of amenorrhoea . Vaginal bleeding any
time after 12 months of amenorrhoea in a woman of menopausal age is known as
postmenopausal bleeding. The Menopause is a biological phenomenon in the process of
ovarian ageing which occurs around the age of 50. Average age of menopause is approximately
51.4 years. In India it varies between 45-50 years (1)The loss of ovarian follicular activity causes
a marked fall in the secretion of estrogen, progesterone and other hormones by the ovary so
that the cyclical endometrial development and hence the menstruation cease. Deficiency of
estrogen begins with its own specific long term degenerative consequences and increased
susceptibility for genital malignancies. There is a basic level of information which all women
need so that they can interpret any symptom they experience and seek advice to lead healthy
lives. The most feared symptom is one of postmenopausal bleeding which unless proved
otherwise indicates genital malignancy. If the profession or community? at large could be
made to realize this single fact, more women could be brought to treatment relatively early and
many more cures could be affected. In the present study we make an attempt to find out
incidence in cases presenting, with the ominous symptom of postmenopausal bleeding in our
region and relation of sociodemographc factors with postmenopausal bleeding.
METHODS
The cases in present study were the women of menopausal age with vaginal bleeding or blood
stained vaginal discharge at any time after 12 months of amenorrhoea, who attended the
Department of Obstetrics and Gynaecology, Dr. B.R.A.M. Hospital, Raipur (C.G.) .The study
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continued for twelve months. Total 4111 patients attended Gyneac. OPD out of which 146
patients of menopausal age came with the complain of vaginal bleeding after twelve months or
more period of amenorrhoea. A detailed, precoded, pre-tested, structured, closed
questionnaire was used to collect the data after informed consent was obtained. By
interviewing these women, information was collected about different demographic factors like
age, socioeconomic status, parity etc.The collected data was put in the master chart. They were
grouped and tabulated according to the various criteria and results were analyzed.
RESULTS
In this study, 4111 patients attended Gyneac. OPD out of which 146 patients of menopausal age
came with the complain of vaginal bleeding after twelve months or more period of
amenorrhoea . The incidence of cases of postmenopausal bleeding was 3.5%. Denominator in
calculating Incidence rate will be Total number of patients AT RISK. As the other patients are
not of menopausal age, this is not applicable. Proportionof cases can be calculated.
Table 1
Socio- demographic characteristics of the participants
Socio- demographic characteristics
Percent
4
Age Distribution (In years)
<45
2
45-54
50
55-64
29
65-74
13
>75
6
Participants education
Illiterate
62
Primary
22
Middle
1
Higher secondary
4
Graduates and above
1
Residence
5
Rural
60
Urban
40
Parity
Nulliparous
2
Uniparous
1
Multiparous
32
Grand multiparous
65
Class (Prasad's)
I
-
II
-
III
20
IV
48
V
32
In
the
present
study maximum no. abbreviation not to be used in text as far as possible. of cases with
postmenopausal bleeding were found in the age group of 45-54yrs (50%). Next to this, was age
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group of 55-64yrs (29 %). The youngest patient was of 42years and the oldest patient was of
80years. Average age of the patients was 55 yrs (S.D. 8.9). 60 % of total cases came from rural
areas, whereas 40% of cases were from urban areas. Most of the patients were illiterate
accounting for 62% of total cases. 22% of the total cases were educated up to primary school.
Only one patient was postgraduate.65% of the patients were grand multipara (Parity 4). Rests
were multipara (32%). Only two patients were nullipara and one patient was uniparous .Most
of the patients belong to lower socioeconomic strata. 48% of cases were of Prasad's class IV.
DISCUSSION
In this study the incidence of postmenopausal bleeding in out patients of our department was
3.5%. Benzie R.J. (2) reported 132 cases of postmenopausal bleeding representing 2.9% of total
gynaecological admissions during the period under review.
In the study under discussion, the ages of the patients ranged from 42 yrs to 80 yrs with an
average of 55 yrs. (S. D. 8.9). The highest incidence of cases was between 45-54 years after
which it declined with increasing age. In the study by Pacheco & Kempers (3), maximum
numbers of patients (93 out of 401) were between 55-59 years. Similarly in the study by Keirse
(4) highest incidence of Postmenopausal bleeding was (50.6%) observed in age group of 55-64
yrs. Studies quoted are very old.
In the present study, 60% of the patients were of rural areas. Our hospital being the only
tertiary centre in the state, serves all the nearby rural areas. In this study, 62% of the patients
were illiterate. Lack of education led to ignorance of spotting or staining after the menopause
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with the result of presentation after long period with advanced stages of cancer. Being a
government hospital, this institution serves mainly the lower social classes. In our study all
patients belong to either class III, IV or V of Prasad's scale
We found multiparty to be a high risk factor for Postmenopausal bleeding. In the present study
65% of cases were grandmultipara and 32% of cases were multipara Compare with other
studies.
REFERENCES
1) Shaw: Physiology Shaw’s textbook of Gynecology 1994, Edition 11: 53.
2) Benzie RJ:Postmenopausal genital bleeding. N analysis of 132 cases.
Australian and New Zealand Journal of Obst and Gynec 1967, 7. 73.
3) Pacheco, JC and kempers RD:Etiology postmenopausal bleeding.
Obstetrics and Gynecology 1964, 32:40.
4 ) Keirse MJNC: Etiology of postmenopausal bleeding.
Postgraduate medical Journal 1973, -19: 344-348.
Reviewer’s Comments and suggestions for editors: Although the methdoloty and study design
are correct, data is not substantial for a full paper.
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Proportion rather than Incidence of cases should be used as the denominator does not reflect
population at risk. Subsequently, key word should be changed.
The main finding in conclusion ( association f multiparity with post menopausal bleeding )
should be included in abstract. Comment about Incidence rate is not correct and should be
removed.
Discussion should be corrected in light of above .
The references quoted are very old dating back to 1964. They should be updated.
The paper can be improved by adding more data such as
After how many years of menopause did the women have post-menstrual bleeding
Was it associated with any systemic disease such as hypertension or obesity? Etc.
Overall recommendation: Revision required before considering publication.