Does persistent postmenopausal bleeding justify hysterectomy?

Postmenopausal vaginal bleeding is an early sign of endometrial cancer. persistent postmenopausal bleeding refers to uterine bleeding for which no malignant cause can be demonstrated by endometrial sampling. Hysterectomy has routinely been performed in this group of patients because of a perceived risk of endometrial cancer. The objective of this study was to quantify the risk of endometrial cancer in patients undergoing hysterectomy for postmenopausal bleeding after benign histology on endometrial sampling. One thousand four hundred and sixty-three patients underwent a hysterectomy during the study period. Forty hysterectomies (2.7%) were performed for persistent postmenopausal bleeding. The final pathology of the 40 hysterectomy specimens demonstrated hyperplasia with atypia in four patients (10%), hyperplasia without atypia in 14 (35%), and other non malignant pathology in 22 (55%). There were no cases of carcinoma of the endometrium. We conclude that persistent postmenopausal bleeding with non malignant pathology on endometrial sampling is not an indication for hysterectomy.