Recurrent postmenopausal bleeding: Pathological findings and predictive factors. A multicenter, prospective, observational study
Abstract Introduction Recurrent postmenopausal bleeding (PMB) occurs in 6%–25% of postmenopausal women who have experienced a previous episode of PMB. The question of whether recurrent PMB leads to a higher risk of endometrial cancer (EC) in comparison to a single episode of PMB is, however, controv...
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Wiley
2024-07-01
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| Series: | Acta Obstetricia et Gynecologica Scandinavica |
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| Online Access: | https://doi.org/10.1111/aogs.14851 |
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| author | Laura D. P. R. vanMaldegem Johanna A. van derZande Lucy A. vanWerkhoven Patricia C. Ewing‐Graham Bernadette A. M. Heemskerk‐Gerritsen Helena C. vanDoorn |
| author_facet | Laura D. P. R. vanMaldegem Johanna A. van derZande Lucy A. vanWerkhoven Patricia C. Ewing‐Graham Bernadette A. M. Heemskerk‐Gerritsen Helena C. vanDoorn |
| author_sort | Laura D. P. R. vanMaldegem |
| collection | DOAJ |
| description | Abstract Introduction Recurrent postmenopausal bleeding (PMB) occurs in 6%–25% of postmenopausal women who have experienced a previous episode of PMB. The question of whether recurrent PMB leads to a higher risk of endometrial cancer (EC) in comparison to a single episode of PMB is, however, controversial. Furthermore, little is known about predictive factors for recurrent PMB. Material and Methods A multicenter prospective cohort study was conducted over a 5‐year period in four hospitals in the Netherlands. Women with PMB undergoing endometrial sampling and aged 40 years and older were included. Occurrence of recurrent PMB was retrospectively determined. Primary outcomes included (1) the incidence of recurrent PMB and (2) differences in pathological findings between patients with a single episode vs recurrent PMB. Secondary outcomes included (1) the association between diagnosis of benign polyps at first PMB and pathological findings at recurrent PMB and (2) factors predictive for recurrent PMB. Results A total of 437 women with PMB were included, of whom 360 were at risk of recurrent PMB. With a median follow‐up of 61 months (IQR (Interquartile range) 44–73), 26.4% experienced recurrent PMB. Patients with recurrent PMB were more often diagnosed with benign polyps (34.7% vs. 25.1%, p‐value 0.015) and less frequently with a malignancy (5.3% vs. 17.8%, p‐value 0.015), compared to patients with a single episode of PMB. Benign polyps at initial PMB were not associated with a (pre)malignancy at recurrence (OR 4.16, 95% CI 0.75–23.03). Predictive factors for recurrent PMB included use of hormone replacement therapy (HRT) (OR 3.32, 95% CI 1.64–6.72), and benign polyps at initial PMB (OR 1.80, 95% CI 1.07–3.04). Conclusions Recurrent PMB is common in women with a previous episode of PMB. Compared to patients with a single episode of PMB, patients with recurrent PMB and benign histological outcomes at accurate workup during their first episode were less often diagnosed with malignancies and more frequently with benign polyps. Benign polyps at first PMB are predictive for recurrent PMB, but not for a higher risk of (pre)malignancy. |
| format | Article |
| id | doaj-art-1716079680c54ea4a6e86bd3d7b386f4 |
| institution | OA Journals |
| issn | 0001-6349 1600-0412 |
| language | English |
| publishDate | 2024-07-01 |
| publisher | Wiley |
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| series | Acta Obstetricia et Gynecologica Scandinavica |
| spelling | doaj-art-1716079680c54ea4a6e86bd3d7b386f42025-08-20T02:09:24ZengWileyActa Obstetricia et Gynecologica Scandinavica0001-63491600-04122024-07-0110371283129110.1111/aogs.14851Recurrent postmenopausal bleeding: Pathological findings and predictive factors. A multicenter, prospective, observational studyLaura D. P. R. vanMaldegem0Johanna A. van derZande1Lucy A. vanWerkhoven2Patricia C. Ewing‐Graham3Bernadette A. M. Heemskerk‐Gerritsen4Helena C. vanDoorn5Department of Gynecologic Oncology Erasmus MC Cancer Institute, University Medical Center Rotterdam Rotterdam the NetherlandsDepartment of Gynecologic Oncology Erasmus MC Cancer Institute, University Medical Center Rotterdam Rotterdam the NetherlandsDepartment of Gynecologic Oncology Erasmus MC Cancer Institute, University Medical Center Rotterdam Rotterdam the NetherlandsDepartment of Pathology Erasmus MC Cancer Institute, University Medical Center Rotterdam Rotterdam the NetherlandsDepartment of Medical Oncology Erasmus MC Cancer Institute Rotterdam the NetherlandsDepartment of Gynecologic Oncology Erasmus MC Cancer Institute, University Medical Center Rotterdam Rotterdam the NetherlandsAbstract Introduction Recurrent postmenopausal bleeding (PMB) occurs in 6%–25% of postmenopausal women who have experienced a previous episode of PMB. The question of whether recurrent PMB leads to a higher risk of endometrial cancer (EC) in comparison to a single episode of PMB is, however, controversial. Furthermore, little is known about predictive factors for recurrent PMB. Material and Methods A multicenter prospective cohort study was conducted over a 5‐year period in four hospitals in the Netherlands. Women with PMB undergoing endometrial sampling and aged 40 years and older were included. Occurrence of recurrent PMB was retrospectively determined. Primary outcomes included (1) the incidence of recurrent PMB and (2) differences in pathological findings between patients with a single episode vs recurrent PMB. Secondary outcomes included (1) the association between diagnosis of benign polyps at first PMB and pathological findings at recurrent PMB and (2) factors predictive for recurrent PMB. Results A total of 437 women with PMB were included, of whom 360 were at risk of recurrent PMB. With a median follow‐up of 61 months (IQR (Interquartile range) 44–73), 26.4% experienced recurrent PMB. Patients with recurrent PMB were more often diagnosed with benign polyps (34.7% vs. 25.1%, p‐value 0.015) and less frequently with a malignancy (5.3% vs. 17.8%, p‐value 0.015), compared to patients with a single episode of PMB. Benign polyps at initial PMB were not associated with a (pre)malignancy at recurrence (OR 4.16, 95% CI 0.75–23.03). Predictive factors for recurrent PMB included use of hormone replacement therapy (HRT) (OR 3.32, 95% CI 1.64–6.72), and benign polyps at initial PMB (OR 1.80, 95% CI 1.07–3.04). Conclusions Recurrent PMB is common in women with a previous episode of PMB. Compared to patients with a single episode of PMB, patients with recurrent PMB and benign histological outcomes at accurate workup during their first episode were less often diagnosed with malignancies and more frequently with benign polyps. Benign polyps at first PMB are predictive for recurrent PMB, but not for a higher risk of (pre)malignancy.https://doi.org/10.1111/aogs.14851endometrial cancerendometrial neoplasmsendometrial polyppostmenopausal bleedingrecurrencerecurrent postmenopausal bleeding |
| spellingShingle | Laura D. P. R. vanMaldegem Johanna A. van derZande Lucy A. vanWerkhoven Patricia C. Ewing‐Graham Bernadette A. M. Heemskerk‐Gerritsen Helena C. vanDoorn Recurrent postmenopausal bleeding: Pathological findings and predictive factors. A multicenter, prospective, observational study Acta Obstetricia et Gynecologica Scandinavica endometrial cancer endometrial neoplasms endometrial polyp postmenopausal bleeding recurrence recurrent postmenopausal bleeding |
| title | Recurrent postmenopausal bleeding: Pathological findings and predictive factors. A multicenter, prospective, observational study |
| title_full | Recurrent postmenopausal bleeding: Pathological findings and predictive factors. A multicenter, prospective, observational study |
| title_fullStr | Recurrent postmenopausal bleeding: Pathological findings and predictive factors. A multicenter, prospective, observational study |
| title_full_unstemmed | Recurrent postmenopausal bleeding: Pathological findings and predictive factors. A multicenter, prospective, observational study |
| title_short | Recurrent postmenopausal bleeding: Pathological findings and predictive factors. A multicenter, prospective, observational study |
| title_sort | recurrent postmenopausal bleeding pathological findings and predictive factors a multicenter prospective observational study |
| topic | endometrial cancer endometrial neoplasms endometrial polyp postmenopausal bleeding recurrence recurrent postmenopausal bleeding |
| url | https://doi.org/10.1111/aogs.14851 |
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