RECURRENT POSTMENOPAUSAL BLEEDING: PATHOLOGICAL FINDINGS AND PREDICTIVE FACTORS

Background: Postmenopausal bleeding (PMB) is a common but abnormal symptom requiring urgent evaluation. Atrophy is the leading cause, though postmenopausal bleeding might signal endometrial cancer. Early detection improves outcomes, emphasizing timely diagnosis and management to prevent malignancy progression. Objectives: The study aims to determine the prevalence of endometrial pathology in women with recurrent postmenopausal bleeding, identify predictive clinical and demographic factors, and assess the diagnostic accuracy of imaging and biopsy methods. Methods: This is a prospective observation study conducted at Al-Hakeem Teaching Hospital, Misan City, for the duration from 1st of September 2024 till 1st of September 2025 in Iraq. The study included 100 women aged ≥ 45 years with a complaint of recurrent postmenopausal bleeding. Data collection included demographic, gynecological, medical history, BMI, and findings of physical examination. All participants underwent transvaginal ultrasound for endometrial thickness, followed by outpatient endometrial sampling by Pipelle for histopathological evaluation in those with ≥ 4mm endometrial thickness to identify the prevalence and types of endometrial pathology. Results: This study of 100 women with recurrent postmenopausal bleeding found a mean age of 62.5± 7.3 years. Histopathology revealed pathology in 62%, including 9% carcinoma. Significant associations were identified between endometrial pathology and older age (p=0.001), longer menopausal duration (p=0.041), greater number of bleeding episodes (p=0.006), and increased endometrial thickness ≥ 4 mm on ultrasound (p=0.001). Conclusions: Significant predictors included older age, longer menopausal duration, multiple bleeding episodes, and endometrial thickness ≥4 mm, underscoring key diagnostic and risk factors.