Histopathologic findings in women with postmenopausal bleeding: implication for endometrial thickness and circulating levels of sex steroid hormones.

Objective: The aim of this study is to compare the relationship between estrone (E1), estradiol (E2), androgens, and prolactin blood levels on the one hand, and endometrial thickness and related histopathologic results on the other, in postmenopausal women admitted with uterine bleeding.

Methods: The study was conducted in Gazi University School of Medicine, Obstetrics and Gynecology Clinic with a total of 128 patients. The study group consisted of 64 postmenopausal patients admitted with uterine bleeding, whereas the control group consisted of 64 healthy postmenopausal women. Vaginal sonography was performed to evaluate the endometrial thicknesses of the patients. Serum levels of free testosterone, androstenedione and estrone (E1) were determined by radioimmunoassay while serum estradiol (E2), prolactin, and dehydroepiandrosterone sulfate (DHEA-S) levels were evaluated by chemiluminescent method.

Results: The median age, duration of menopause, menopausal age and gravidity, and parity did not differ between women with postmenopausal bleeding and the control group (P > 0.05). However, DHEA-S level was lower (P < 0.05) and endometrial thickness was greater in the study group than the control group (P < 0.05). Furthermore, the study identified that median endometrial thickness of the patients in atrophic endometrium group was less than the endometrial hyperplasia and endometrium carcinoma group (P < 0.05).

Conclusion: In the current study, all these hormones seemed to be indifferent between groups of endometrial cancer and other pathological results. Based on our results regarding the safe margin of endometrial thickness in women with postmenopausal bleeding, it seems justifiable to refrain from curettage in patients with an endometrium of < or =4 mm.