Women with recurrent postmenopausal bleeding should be re-investigated but are not more likely to have endometrial cancer.

Objectives: We aimed to determine the prevalence of endometrial cancer in patients presenting with recurrent postmenopausal bleeding (PMB) after initial negative investigations.

Study Design: This was a retrospective study carried out in a dedicated PMB clinic. All patients presenting with recurrent PMB between 1 January 2003 and 31 May 2009 were studied. All patients had transvaginal ultrasound, speculum examination and endometrial sampling attempted. Main outcome measure The prevalence of endometrial cancer in patients presenting with recurrent PMB after initial negative investigations.

Results: A total of 1536 women with PMB were seen over a period of 56 months. Sixty-six required definitive treatment after their first visit. One hundred and twenty-six re-presented with recurrent bleeding. The prevalence of endometrial cancer in women presenting for the first time with PMB was 3.04% whereas that in women presenting with recurrent PMB after initial negative investigations was 4%. One of these women re-presented within six months of initial visit and another within one year. All the other cancers were diagnosed more than one year after initial negative investigations (range 19.6-57.1 months). One woman had an endometrial cancer even though the endometrial thickness was less than 3 mm.

Conclusions: Women with recurrent PMB after initial negative investigations are no more likely to have endometrial cancer than those presenting for the first time but re-investigation is indicated if six months has elapsed.