Molar pregnancy in the perimenopausal period: a case report

Molar pregnancy is an uncommon diagnosis in perimenopausal women and poses a high risk of complications, including hemorrhagic shock and malignant transformation. We report the case of a 51-year-old woman who presented with severe abdominal pain and profuse vaginal bleeding. Imaging revealed a markedly enlarged uterus with a large intracavitary mass, and serum β-hCG levels were elevated. The patient developed hemorrhagic shock and underwent an emergency hemostatic hysterectomy. Histopathological examination confirmed a complete hydatidiform mole with early invasive features, without choriocarcinoma. Postoperative imaging showed no metastases, and the patient received methotrexate-based chemotherapy with favorable response, evidenced by a progressive decline in β-hCG levels. This case underscores the importance of considering gestational trophoblastic disease in the differential diagnosis of abnormal uterine bleeding in perimenopausal women. Early recognition and timely surgical intervention, followed by appropriate chemotherapy and monitoring, are crucial to avoid potentially life-threatening complications.