ENDOMETRIAL NEOPLASIA

POSTMENOPAUSAL BLEEDING

A   65-year-old patient complains   of  vaginal bleeding    for three   months. Her

last    menstrual   period  was at  age 52. She has not taken   any hormone

replacement.    She was diagnosed   with    type    2   diabetes    20  years   ago and was

treated with    oral    hypoglycemic    agents. She has chronic hypertension,   for

which   she is  treated with    oral    antihypertensives.  Her height  is  62  inches  and

weight  200 lb. Physical    examination is  normal  with    a   normal-sized    uterus

and no  vulvar, vaginal,    or  cervical    lesions.

Postmenopausal bleeding is any bleeding that occurs after menopause. A patient
is considered to be in menopause after 3 continuous months of cessation of
menses and elevated gonadotropins. Menopause usually occurs at around age

Endometrial carcinoma is the most common gynecologic malignancy (1% of
women), with age 61 the mean age at diagnosis. Lynch syndrome, an
autosomally dominant disease, accounts for 2–5% of all endometrial carcinoma
(mean age at diagnosis age 50). In women with Lynch, lifetime risk of
endometrial cancer is 10–20 times the general population.

There is no screening test.

The differential diagnosis of postmenopausal bleeding includes endometrial
carcinoma, vaginal or endometrial atrophy, and postmenopausal hormonal