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.

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.