Etiologies of Postmenopausal Bleeding in Elderly Women using PALM-COEIN Classification

Introduction: Postmenopausal bleeding (PMB) is a kind of abnormal uterine bleeding that has different underlying etiologies as compared to perimenopausal and nonelderly women. The present study was carried out to study the spectrum of underlying etiologies of PMB in an elderly population using PALM-COEIN classification. Methods: This study evaluated the hospital records of 118 elderly women (>60 years) presenting with PMB. Age, obstetric history, menopausal history, duration of complaints, and medical and surgical history were noted. All the patients underwent complete clinical, laboratory, and sonographic evaluations. Cases with suspicious etiology underwent endometrial biopsy. Final diagnosis was made with clinical, sonographic, and histopathological correlation using PALM-COEIN classification. Data were displayed as numbers and percentages or mean ± standard deviation. Results: The mean age of women was 68.73 ± 5.98 years. The mean time since menopause was 22.30 ± 6.57 years. The mean duration of current complaints was 6.82 ± 7.97 days. PALM (structural) etiologies were ascertained in 99 (83.9%) patients, while COEIN (nonstructural) etiologies were established in 19 (16.1%) women. Adenomyosis (26.3%), polyps (24.6%), and leiomyoma (22.9%) were the common PALM etiologies. Malignancy rate was 10.2%. Nonstructural etiologies were dominated by endometrial causes (9.3%). None of the patients had ovulatory causes. Conclusion: Elderly patients with PMB had a dominance of structural etiologies. Malignancy rate in these patients was quite high.