Recurrent postmenopausal bleeding - just endometrial disease or ovarian sex cord-stromal tumor? A case report

BACKGROUND Postmenopausal bleeding(PMB)is a common gynecologic complaint among elderly women,and endometrial hyperplasia is a common cause of this bleeding.Ovarian fibromas are the most common type of ovarian sex cord-stromal tumor(SCST).They arise from non-functioning stroma,rarely show estrogenic activity,and stimulate endometrial hyperplasia,causing abnormal vaginal bleeding.CASE SUMMARY We report herein the case of a 64-year-old Chinese woman who presented with recurrent PMB.A sex hormone test revealed that her estrogen level was significantly higher than normal,and other causes of hyperestrogenism had been excluded.The patient had undergone four curettage and hysteroscopy procedures in the past 7 years due to recurrent PMB and endometrial hyperplasia.The culprit behind the increase in estrogen level—an ovarian cellular fibroma with estrogenic activity—was eventually found during the fifth operation.CONCLUSION Ovarian cellular fibromas occur insidiously,and some may have endocrine functions.Postmenopausal patients with recurrent PMB and endometrial thickening observed on ultrasonography are recommended to undergo sex hormone testing while waiting for results regarding the pathology of the endometrium.If the estrogen level remains elevated,the clinician should consider the possibility of an ovarian SCST and follow-up the patient closely,even if the imaging results do not indicate ovarian tumors.Once the tumor is found,it should be removed as soon as possible no matter the size to avoid endometrial lesions due to long-term estrogen stimulation.More studies are needed to confirm whether preventive total hysterectomy with bilateral salpingo-oophorectomy should be recommended for women with recurrent PMB exhibiting elevated estrogen levels,despite the auxiliary examination results not indicating ovarian mass.The physical and psychological burden caused by repeated curettage could be prevented using this technique.

The Prognostic Value of BMI, Serum Glucose, Endometrial Echo Pattern and Uterine Artery Doppler Velocimetry as a Predictor for Endometrial Pathology in Women with Postmenopausal Bleeding (Prospective Observational Study)

Background: Post-menopausal bleeding is a warning sign that accounts for about 5% of all outpatient gynaecologic visits and is a common indication for referral to rapid access clinics because of the fear of underlying malignancy. Endometrial malignancies differ from other malignancies in that early symptomization is common, allowing early cure. Patients and Methods: During the study period, 100 women with post-menopausal bleeding having inclusion criteria were evaluated in Al Hussein University Hospital. For each patient full history, general, abdominal and pelvic examination was performed. Routine pre-operative investigations were done. Patients were divided into four groups: Group 1 included 29 patients with endometrial polyp. Group 2 included 34 patients with endometrial hyperplasia. Group 3 included 21 patients with atrophic endometrium. Group 4 included 16 patients with endometrial carcinoma. Results: As regards the predictive value of BMI, in the study there was a high statistical significance in comparison between the endometrial carcinoma group and all other benign groups. When discussing the predictive value of blood glucose level, in the study there was a high statistical significance in comparison between the endometrial carcinoma group and all other benign groups. It is worth to mention that the predictive value of endometrial thickness, in the study, was with high statistical significance in comparison between the endometrial carcinoma group and all other benign groups providing the highest specificity and sensitivity. At the last the predictive value of uterine artery velocimetry, in the study, was with high statistical significance in comparison between the endometrial carcinoma group and all other benign groups. Conclusion: BMI, blood glucose level, endometrial thickness and uterine artery velocimetry indices, improve the prediction of endometrial carcinoma in women with post-menopausal bleeding.

Postmenopausal Bleeding and Changing Bleeding Patterns after Parental Use of Corticosteroids: A Prospective Cohort Study

Objective: To study whether there is a relation between the application of corticosteroids and occurrence of postmenopausal bleeding. Also we want to determine whether corticosteroids can cause an irregularity in a previously regular menstruation cycle. Design and Setting: Prospective cohort study in the department of anesthesiology. Patients: 209 women who received a single dosage of corticosteroids as treatment for pain. Interventions: None, observational cohort study;all women received standard care. Main outcome measures: Postmenopausal blood loss or disruption of menstruation cycle. Result: Postmenopausal blood loss or disruption of menstruation cycle were both more common 6 weeks after administration of corticosteroids, but were sometimes also reported 2 weeks after administration of corticosteroids. Conclusion: After administration of corticosteroids in a postmenopausal woman an episode of menstruation like bleeding can be expected. This is probably due to a transient drop of androstenedione. In premenopausal women a transient change in menstruation cycle can be observed.

Regular menses at 73? A peculiar presentation of postmenopausal bleeding

Post menopausal bleeding is one of the most common conditions referred to gynaecology departments. Up to 5% of these women are found to have malignant, or pre-malignant lesions, with early detection and investigation being crucial for curative treatment. We report on the case of a 73-year-old women referred for having regular menses since 14 years of age and discuss the current investigation and management of post menopausal bleeding.

Pattern of Presentation and Associated Morbidities of Women Presenting with Postmenopausal Bleeding

Background: Postmenopausal bleeding (PMB) is caused mainly by benign disorders;however it is sometimes caused by endometrial cancer. Aim: We here attempted to determine what conditions account for PMB in an outpatient clinic of a University hospital in London. Methodology: Study subjects consisted of 179 patients with PMB who were referred to us from July to December 2019. Sociodemographic data including patient’s age, risk factors, diagnosis and management were reviewed. Underlying conditions where determined. Results: Of 179 subjects, the following findings were made: 1) Age 59.63 ± 8.3 (mean and standard deviation). 2) Parity;multiparity, 57.0% (mean ± 1.67). 3) First episode of PMB, 77.1%. 4) The most frequently observed risk factor;obesity 34.6%. 5) The following accounted for PMB (diagnosis in order of incidence rate);genital atrophy 37.4%, submucosal fibroid 28.5%, endometrial polyp 20.7%, endometrial hyperplasia 6.7%, and endometrial cancer 5.6%. All patients were treated appropriately. We did not determine the prognosis of patients with endometrial cancer. Conclusion: Although the incidence of rate among women with PMB has already been reported, its reconfirmation in a single facility is important for making policies in the treatment of PMB.

宫腔镜及B超联合诊治绝经后出血的临床价值研究

目的探讨宫腔镜及B超联合诊治绝经后出血的临床价值。方法选取160例绝经后出血患者,均行宫腔镜、B超检查,观察患者临床特征和病理结果。结果经病理检查结果显示,子宫内膜增生43例(26.88%)、子宫内膜息肉76例(47.50%)、宫颈管息肉12例(7.50%)、子宫黏膜肌瘤21例(13.13%)、子宫内膜癌8例(5.00%)。宫腔镜+B超检查的诊断率、符合率、治愈率均高于宫腔镜检查或B超检查(P<0.05)。结论宫腔镜结合阴道B超检查能有效地提高绝经后子宫出血的检出率,对患者的早期诊断和治疗具有重要意义。

宫腔镜检查与诊断性刮宫在绝经后阴道出血病因诊断中的应用价值

目的比较宫腔镜检查与诊断性刮宫在绝经后阴道出血(PMB)病因诊断中的临床应用价值。方法回顾性选取2018年5月至2020年6月在首都医科大学附属北京康复医院妇科行宫腔镜检查及诊断性刮宫的PMB患者各120例,比较宫腔镜检查与诊断性刮宫对PMB病因诊断的价值。结果宫腔镜检查19例未见宫腔异常,101例见宫腔病变,包括27例子宫内膜息肉(EP)、20例子宫内膜增殖症(EH)、12例宫腔粘连(IUA)、10例子宫内膜癌(EC)、12例宫腔感染、20例子宫黏膜下肌瘤(SUM)。诊断性刮宫21例未见宫腔异常,99例见宫腔病变,包括30例EP、20例EH、15例IUA、6例EC、13例宫腔感染、15例SUM。以术后病理学诊断结果作为金标准,宫腔镜检查的确诊率为92.50%,误诊率为5.83%,漏诊率为1.67%;诊断性刮宫的确诊率为91.67%,误诊率为5.83%,漏诊率为2.50%。宫腔镜检查诊断PMB患者宫腔病变的敏感度为97.92%,特异度为70.83%,准确率为92.50%,诊断性刮宫诊断PMB患者宫腔病变的敏感度为96.84%,特异度为72.00%,准确率为91.67%,二者的敏感度、特异度及准确率比较差异均无统计学意义(P>0.05)。结论宫腔镜检查与诊断性刮宫在PMB病因诊断中均有一定的应用价值,有助于进一步指导临床治疗。

绝经后出血病人子宫内膜病变风险列线图构建与验证

目的:探讨绝经后出血病人子宫内膜病变的风险列线图模型的构建与验证。方法:回顾性分析2020年1月—2022年1月妇幼保健院收治的120例绝经后出血病人的临床资料,根据其是否发生子宫内膜病变将其分为发生组与未发生组,收集病人治疗前后相关数据,对其进行危险因素分析并构建风险列线图模型,另选取2022年2月—2023年1月妇幼保健院收治的50例绝经后出血病人,将其设为验证组,收集治疗前后相关数据,对风险列线图模型进行验证。结果:发生组病人59例(49.17%),未发生组病人61例(50.83%),多因素分析显示,两组的绝经年限[OR=2.603,95%CI(1.742,3.890),P<0.001]、子宫内膜厚度[OR=3.496,95%CI(1.244,9.830),P=0.018]、反复性阴道出血[OR=4.219,95%CI(1.339,13.294),P=0.014]等为绝经后出血病人子宫内膜病变的独立危险因素,构建风险列线图:Logit(P)=0.957×绝经年限+1.252×子宫内膜厚度+1.440×反复性阴道出血-8.515。其受试者工作特征(ROC)曲线下面积为0.894[95%CI(0.838,0.950)],灵敏度为79.7%,特异度为85.2%,Youden指数为0.649,P<0.001,Hosemer-Lemeshow检验显示χ^(2)=9.358,P=0.313。结论:构建的绝经后出血病人子宫内膜病变的风险列线图模型预测效能良好,可为临床早期识别绝经后出血发生子宫内膜病变高风险病人提供参考,并为医疗护理方案的制订提供依据。

妇科超声检查诊断绝经后阴道出血的临床价值研究

目的分析妇科超声检查对绝经后阴道出血患者的诊断效能。方法选取80例绝经后阴道出血患者为研究对象,均接受妇科超声检查及子宫刮宫病理诊断,将超声检查结果与刮宫病理学检查结果进行对比,计算绝经后阴道出血的超声检查准确率。结果80例绝经后阴道出血患者中,经妇科超声检查诊断子宫肌瘤40例,子宫内膜癌13例,子宫内膜增生12例,子宫内膜息肉14例;经刮宫病理学诊断子宫肌瘤40例,子宫内膜癌16例,子宫内膜增生14例,子宫内膜息肉10例。妇科超声检查准确率为98.75%,与刮宫病理学诊断的100%比较,差异无统计学意义(P>0.05)。结论妇科超声检查能够对绝经后阴道出血患者进行有效诊断,最终诊断结果与病理学检查结果相近,说明妇科超声检查能准确分辨子宫内膜病变的具体情况,对患者病情做出具体判断,从而为后续治疗方案的制订奠定坚实基础。

电视宫腔镜诊治91例绝经后子宫出血的效果分析

目的 :回顾性分析电视宫腔镜对绝经后子宫出血的诊断和治疗效果。方法 :对 91例绝经后子宫出血患者行宫腔镜检查 ,其中 2 1例行电切术或病灶摘除术 ,病变组织送病理。结果 :绝经后出血的病因依次为粘膜下肌瘤、子宫内膜炎、子宫内膜息肉、子宫内膜单纯增生、萎缩性子宫内膜、子宫内膜癌等 ,宫腔镜诊断与病理诊断符合率依次为 :95 .2 %、10 0 %、88.9%、10 0 %、90 %、80 %。宫腔镜治疗宫腔良性病变所致子宫出血无一例复发。结论 :宫腔镜诊断绝经后子宫出血 ,优于诊断性刮宫 ;部分患者可同时行病灶摘除或电切术 ,减少了开腹手术对患者的创伤。

179例老年妇女绝经后子宫出血或超声宫腔异常的子宫内膜病变特点

目的探讨绝经后老年妇女子宫内膜良恶性病变的特点。方法 1999年1月～2008年12月,179例60～89岁的老年妇女因绝经后子宫出血或B超提示宫腔异常入院,经宫腔镜检查与病理诊断,142例患有子宫内膜良恶性病变,37例子宫内膜正常。本文回顾性分析142例子宫内膜病变的特点,根据子宫内膜病变性质分为良性组108例、恶性组34例,并对两组间的年龄、绝经年龄、绝经时间、孕产次、子宫大小与子宫内膜厚度进行比较。结果子宫内膜良性病变108例,包括子宫内膜息肉59例(41.5%)、萎缩性子宫内膜炎29例(20.4%)、子宫黏膜下肌瘤10例(7.0%)、子宫内膜增殖症6例(4.2%)、子宫内膜息肉样腺肌瘤4例(2.8%);子宫内膜恶性病变34例,包括子宫内膜癌32例(22.5%)、子宫肉瘤1例(0.7%)、子宫内膜间质肿瘤1例(0.7%)。良性组与恶性组之间的比较:2组年龄、绝经年龄、绝经时间和孕产次无统计学差异;恶性组子宫大小及子宫内膜厚度明显大于良性组[(74.0±6.2)cm3vs.(44.2±6.8)cm3,t=22.742,P=0.000;(15.2±7.3)mm vs.(11.3±5.7)mm,t=3.228,P=0.001]。结论绝经后老年妇女的子宫内膜病变主要是子宫内膜息肉、子宫内膜癌、萎缩性子宫内膜炎。恶性子宫内膜病变患者的子宫大小、子宫内膜厚度明显大于良性子宫内膜病变患者,是诊断老年妇女恶性子宫内膜病变的重要依据。

绝经后子宫出血患者子宫内膜病变与血中性激素水平的关系

目的 :探讨绝经后出血妇女子宫内膜病变与血中性激素水平间可能存在的关系。方法 :选取 5 0例绝经后出血妇女 ,抽取肘静脉血 ,放射免疫法分别测定血中FSH、LH、E2 水平 ,同时分段诊刮子宫内膜 ,HE染色、光学显微镜下检查子宫内膜形态。结果 :5 0例绝经后出血妇女血中促卵泡激素 (FSH)、黄体生成素 (LH)、雌激素 (E2 )水平分别为 38.4± 5 .4mIU/ml、33.4± 6 .5mlU/ml、2 9.8± 4 .7pg/ml。分别与正常同龄妇女比较 ,实验组与对照组间差异无显著性。子宫内膜病理检查结果 :萎缩性子宫内膜 2 5例 (5 0 .0 % ) ,单纯性增生过长 11例 (2 2 .0 % ) ,不典型增生 4例 (8.0 % ) ,子宫内膜癌 10例 (2 0 .0 % )。癌性出血患者血中性激素水平无改变。结论 :绝经后妇女子宫出血与血中性激素水平无相关性。

绝经后反复阴道流血病理类型探讨

目的:探讨首次绝经后阴道流血(PMB)子宫内膜病理检查未提示癌变及癌前病变的患者,发生绝经后反复阴道流血(RPMB)的病理诊断结果。方法:回顾性分析1998年1月1日至2013年12月31日期间因RPMB就诊于北京协和医院患者的临床病理资料。结果:北京协和医院15年间因PMB就诊行子宫内膜活检的患者918例中,有RPMB患者112例,首次子宫内膜活检病理检查未提示癌变及癌前病变。RPMB患者中诊断为子宫内膜癌的发生率为8.04%(9/112),与PMB患者的子宫内膜癌发生率7.95%(73/918)比较,差异无统计学意义(P>0.05)。有7例(12.50%)患者在接受全子宫+双侧附件切除术后诊断为卵巢性索间质肿瘤。结论:首次子宫内膜活检病理未提示癌变及癌前病变的RPMB患者子宫内膜癌的风险未增加。反复绝经后阴道流血患者应警惕卵巢性索间质肿瘤。

阴道B超及宫腔镜在诊断绝经后阴道出血的价值

目的 :评价阴道B超 (TVS)及宫腔镜在诊断绝经后出血的准确性。方法 :对 1 98例绝经后出血患者进行TVS检查 ,测量其子宫内膜厚度 ,随后进行宫腔镜检查并在宫腔镜下进行内膜活检 ,将TVS和宫腔镜检查结果与病理检查进行分析、比较。结果 :病理检查结果为 :1 7例未能刮出内膜组织或内膜组织过少不足以作出病理诊断 ,萎缩性子宫内膜 1 0 2例、内膜息肉 2 0例、内膜增殖症 1 7例、子宫内膜癌 1 6例、内膜炎 8例、正常内膜 1 8例。TV显示 1 0 8例内膜厚度≤ 5mm ,90例 >5mm ,所有子宫内膜癌的内膜厚度均 >5mm ,宫腔镜诊断1 4 1例内膜正常 ,57例异常。TVS的敏感性、特异性、阳性预测值及阴性预测值分别为 1 0 0 %、40 %、69.8%、1 0 0 % ,宫腔镜的敏感性、特异性、阳性预测值及阴性预测值分别为 1 0 0 %、89%、93 %、1 0 0 %。结论 :TVS及宫腔镜对诊断绝经后出血敏感性都很高 ,但宫腔镜的特异性高于TVS ,绝经后出血的患者应常规行TVS检查 ,如子宫内膜厚度超过 5mm 。

宫腔镜检查在绝经后子宫出血中的诊断价值

目的探讨宫腔镜检查在绝经后子宫出血中的诊断价值。方法对361例绝经后子宫出血患者行宫腔镜检查,镜下定位取材,并行病理检查。结果绝经后子宫出血以良性病变为主,以子宫内膜息肉发病率最高,其次为萎缩性子宫内膜、子宫黏膜下肌瘤;宫腔镜检查与病理诊断总的符合率为89.08%,符合率从高到底依次为子宫黏膜下肌瘤、子宫内膜息肉、萎缩性子宫内膜、子宫内膜炎、子宫内膜增生及子宫内膜癌。结论宫腔镜检查具有直观性、准确性及全面性,是诊断绝经后子宫出血的首选方法,值得临床推广。

三维能量多普勒超声对女性绝经后出血罹患子宫内膜癌的预测价值

目的探讨三维能量多普勒超声对女性绝经后出血(PMB)罹患子宫内膜癌(EC)的预测价值,进一步分析伴有卵巢囊肿者子宫内膜病变的风险。方法选择2015年10月至2018年10月在西安交通大学第一附属医院就诊的PMB女性386例为研究对象,以子宫内膜病理检查结果为标准,评价内膜厚度(ET)和体积(EV)、血管形成指数(VI)、血流指数(FI)以及血管形成-血流指数(VFI)对EC的预测价值。同时比较伴有卵巢囊肿者和无卵巢囊肿者子宫内膜相关超声指标及内膜病变的风险。结果 386例PMB女性子宫内膜病理检查结果显示正常子宫内膜占 48.96%,子宫内膜良性病变占40.93%,EC占10.10%。正常内膜组、子宫内膜良性病变组、EC组患者ET、EV、VI、FI和VFI差异均有统计学意义(P<0.05),进一步两两比较发现EC组上述指标显著高于正常内膜组和良性病变组(P<0.01),良性病变组显著高于正常内膜组(P<0.05)。子宫内膜FI对EC的预测价值最大(AUC=0.86),其次为VI(AUC=0.84)、VFI(AUC=0.82),而ET的预测价值最小(AUC=0.74)。FI预测的灵敏度(91.00%)、特异度(85.00%)、阳性预测值(85.85%)、阴性预测值(90.43%)均最高,截断值为29.36。进一步比较每两组指标之间的AUC的差异均无统计学意义(P>0.05)。PMB女性中伴有卵巢囊肿者ET、EV、VI、FI和VFI均显著高于无卵巢囊肿组(P<0.05),同时伴卵巢囊肿组者子宫内膜增生不伴非典型增生(EH)、子宫内膜非典型增生(AEH)患病率均显著高于无卵巢囊肿组(P<0.05)。结论三维能量多普勒超声对于PMB女性EC的预测价值优于子宫ET,其中FI的预测价值最高。伴有卵巢囊肿可增加PMB女性子宫内膜病变的风险,值得临床关注。

宫腔镜及B超联合诊治绝经后出血的临床价值

目的：探讨宫腔镜及B超联合诊治技术对于绝经后出血患者的临床价值。方法：对我科2000年2月-2005年8月收治的167例绝经后出血患者进行了宫腔镜及B超联合诊治。所有患者均先进行B超检查，之后行宫腔镜诊治，必要时辅以B超引导监护。结果：167例中84例内膜厚度〈5mm，5—10mm者64例，〉10mm者19例；同时提示宫腔内病变者12例。出血的病因依次为子宫内膜炎54例（32．3％）、子宫粘膜下肌瘤38例（22．8％）、子宫内膜息肉32例（19．2％）、子宫内膜癌22例（13．2％）、子宫内膜增生11例（6．6％）、宫颈息肉6例（3．6％），其它4例（2．3％）。保守治疗11例，化疗1例，31例同时进行了宫腔镜下治疗，99例实施宫腔镜电切手术，25例开腹手术，病理学诊断总的符合率为80．8％。结论：宫腔镜检查联合B超应作为绝经后出血患者的首选，内膜厚度〈5mm者应慎行刮宫术。宫腔镜联合B超进行宫腔内病变治疗及电切手术对于老年宫腔内良性疾患的治疗具有重要临床价值。

绝经后异常子宫出血患者的临床与病理分析

目的探讨绝经后异常子宫出血的最佳临床诊治方法。方法回顾性分析自2019年1月31日至2020年1月31日收治的绝经后异常子宫出血的62例患者,行经阴道超声和宫腔镜检查并根据是否需要进行手术及病理组织学检查。结果62例患者中宫腔镜镜下诊断正常子宫内膜(包括萎缩性内膜和增殖期内膜)13例,子宫内膜厚度均≤10 mm;子宫腔内良性病变共41例,在子宫内膜厚度<5 mm、5~10 mm及>10 mm各区间发病率接近;子宫内膜非典型增生和子宫内膜癌共8例,随着子宫内膜厚度的增加,子宫内膜恶性病变的发病率逐渐增高;62例患者的宫腔镜镜下诊断与术后病理检查结果的符合率为91.9%。结论对于绝经后异常子宫出血的患者,建议行宫腔镜检查及直视下活检,以对子宫腔内病变作出早期诊断与治疗。

绝经后阴道出血相关因素的研究

目的探讨绝经后阴道出血的相关因素。方法通过对４８１例绝经后阴道出血患者的记录资料进行回顾性分析。结果因生殖系统炎症引起的绝经后出血占６７．８７％，生殖系统肿瘤占１４．５％，功能失调性子宫出血占１３．４％。子宫内膜病理显示萎缩性内膜占４８．３４％，依次为增生期、分泌期内膜。恶性肿瘤中以子宫内膜癌和卵巢恶性肿瘤为主，并且出血年龄大，距绝经年限长者，恶性肿瘤发生率高。结论绝经后阴道出血的主要因素是生殖系统炎症，其次生殖系统肿瘤不可忽视。

阴道彩超与宫腔镜在围绝经期及绝经后期子宫出血中的应用分析

目的探讨阴道彩超与宫腔镜在围绝经期及绝经后期子宫出血中诊治的临床应用价值。方法回顾性分析2014年1月至2015年12月间收治的围绝经期及绝经后期子宫出血患者232例。所有患者完成阴道彩超检查和宫腔镜检查并取活检,并将检查结果与病理学诊断对照对比分析。结果宫腔镜对各个疾病诊断的阳性预测率和真阳性率（敏感度）均较阴道彩超高。其中宫腔镜对宫内膜增生、子宫内膜癌、子宫内膜炎诊断的阳性预测率、敏感度与阴道彩超比较,差异均有统计学意义（P〈0.05）。宫腔镜对子宫内膜息肉诊断的敏感度为87.8%,高于阴道彩超的60.6%,差异有统计学意义（P〈0.05）。宫腔镜对子宫内膜生理性改变的诊断中阳性预测率高于阴道彩超,差异有统计学意义（P〈0.05）。阴道彩超显示,厚度为≥4~10mm组的子宫内膜癌检出率低于厚度〉10mm组,差异有统计学意义（χ^2=6.523,P=0.011）。子宫内膜厚度〈4mm组子宫内膜生理性改变的检出率高于厚度≥4~10mm和厚度〉10mm组,差异有统计学意义（χ^2=6.116,P=0.013和χ^2=22.428,P=0.001）。子宫内膜生理性改变≤10mm组中的检出率高于厚度〉10mm组,差异有统计学意义（χ^2=9.13,P=0.003）。结论围绝经期及绝经后期子宫出血可采用阴道彩超常规筛查,宫腔镜较阴道彩超在明确诊断上更有优势,值得临床推广。