Histopathological Evaluation of Endometrial Patterns in Women With Postmenopausal Bleeding and Their Correlation With Clinical and Radiological Features

Background Postmenopausal bleeding (PMB) is a common gynaecological complaint and an important clinical indicator of underlying endometrial pathology, including malignancy. The present study aimed to evaluate histopathological patterns in women presenting with PMB and to correlate these findings with clinical and radiological parameters, particularly endometrial thickness (ET). Materials and methods This one-year observational study included 35 postmenopausal women presenting with bleeding per vaginum. Endometrial tissue obtained via dilation and curettage, pipelle biopsy, or hysterectomy was subjected to histopathological evaluation. Clinical details and transvaginal ultrasonographic ET measurements were recorded. Statistical analysis was performed using a chi-square (χ²) or Fisher’s exact test, with a p-value of < 0.05 considered significant. Results The mean age of the patients was 54.77 ± 6.4 years. Most women were aged 50-59 years (40%), multiparous with parity of two (45.7%), and from urban areas (80%). Histopathological examination revealed benign lesions in 26 cases (74.3%), premalignant lesions in four cases (11.4%), and malignant lesions in five cases (14.3%). Atrophic endometrium was the most common finding (28.6%), followed by endometrial hyperplasia without atypia (20%). ET ranged from <4 mm to >11 mm, with 40% of cases demonstrating ET ≤4 mm. Notably, no premalignant or malignant lesion was identified in cases with ET <4 mm. A statistically significant association was observed between increasing ET and premalignant/malignant histopathology (χ² = 8.90, p = 0.01). Conclusion In this cohort of women with PMB, benign endometrial pathology predominated (74.3%), with atrophic endometrium being the most frequent diagnosis (28.6%). Premalignant or malignant pathologies, in total, accounted for 25.7% of the women with PMB. Increasing ET was significantly associated with these lesions, whereas no such cases were observed with ET ≤4 mm. These findings support the role of ET as a stratification parameter in guiding histopathological evaluation of PMB.