Perimenopausal bleeding patterns and pathologic findings.

Abstract

The charts of 500 sequential perimenopausal patients were reviewed and their alterations in menstrual flow were characterized as fitting one of three patterns. Sixty-two patients (12%) had sudden amenorrhea, 347 (70%) had oligomenorrhea and/or hypomenorrhea, and 91 (18%) had menorrhagia, metrorrhagia, and/or hypermenorrhea. All of the patients in the menorrhagia/metrorrhagia and/or hypermenorrhea group had histologic evaluations to rule out the presence of premalignant or malignant disease; 17 women (19%) in this group had premalignant or malignant findings. In addition, 4 of the 5 women with malignancies had intermenstrual bleeding. Of the 9 women in the study with intermenstrual bleeding, 4 had invasive cancer and 2 had endometrial hyperplasia. This study documents and highlights the high incidence of premalignant and malignant findings in perimenopausal patients with bleeding patterns other than amenorrhea or oligomenorrhea/hypomenorrhea, and underscores the need for perimenopausal women with menorrhagia, metrorrhagia, and/or hypermenorrhea to undergo thorough evaluation.