Etiology Of Early Postmenopausal Bleeding

Objective:To explore the etiology of early postmenopausal bleeding and to provide for avoiding invasive operations in patients with early menopause without organic disease.Methods: Collected 325 patients with postmenopausal bleeding from outpatient and inpatient hospitals of General Hospital of Tianjin Medical University from January 1,2017 to February 28,2018.Collect clinical data of all patients,including age,menopause age,menopausal age,menarche age,pregnancy,parity,endometrial thickness,hysteroscopy results,uterine cavity depth,hypertension,diabetes,Body mass index(BMI),Follicle stimulating hormone(FSH),Estradiol(E2),and pathological findings.According to the patient's menopause years,they were divided into menopause age limit ? 2 years group(group A),2 years <menopausal age limit ? 5 years group(group B)and years of age> 5 years group(group C).According to the patient's FSH levels were divided into FSH <40 mIU / ml group and FSH ? 40 mIU / ml group;Combining hysteroscopy diagnosis with pathological results and referring to preoperative B-ultrasound results,clinical final diagnosis of postmenopausal bleeding patients was divided into no organic disease group,benign disease group and malignant disease group.Compare the data in each group.Results: 1.The menopausal age is 37 to 60 years old,with an average age of(51.25±3.25)years old,A group is(52.27±2.93)years old,B group is(51.81±2.43)years old and C group is(50.89±3.43)years old,The difference of three groups is statistically significant(P=0.010).2.The menarche age ranged from 10 to 20 years,with an average of(14.08±1.39)years,A group is(13.94±1.38)years old,B group is(13.83±1.37)years old,and C group is(14.17±1.39)years old,There is no statistically significant difference between the three groups(P=0.214).3.In this study,50 patients in group A,53 in group B and 222 in group C.The proportion of endometrium without organic lesions,benign lesions and malignant lesions in group A is 46.0%,38.0% and 16.0%;The proportion of endometrium without organic lesions,benign lesions and malignant lesions in group B is 37.7%,49.1% and 13.2%;The proportion of endometrium without organic lesions,benign lesions and malignant lesions in group C is 27.0%,50.5% and22.5%.There was a significant difference between the three groups in the presence of organic lesions in the endometrium(P=0.020);there was no significant difference between the three groups in the presence of benign or malignant lesions in the endometrium(P = 0.539).4.FSH was(39.09±22.84)IU/L in group A,(47.05±27.02)IU/L in group B,and(55.04±23.74)IU/L in group C.There was a statistically significant difference between the three groups(P= 0.005).Further multiple comparison analysis showed a significant difference between group A and group C(P=0.003).The E2 value was(40.19±55.33)pg/mL in group A,(18.77±11.15)pg/m in group B,and(21.86±13.37)pg/m in group C.There was a statistically significant difference between the three groups(P= 0.002).Further multiple comparison analysis showed that there was a significant difference between group A and group B and group C(P=0.002 and 0.001).The proportion of patients with FSH<40 IU/L in the three groups was 63.3%,51.7%,and 28.0%.There was a significant difference between the three groups(P=0.001).5.Endometrial lesions were associated with age,menopausal age,pregnancy,uterine cavity depth,endometrial thickness,body mass index,hypertension,and diabetes Endometrial thickness and diabetes is associated with malignant lesions(P < 0.05).Conclusions: 1.In the etiology of early postmenopausal bleeding,endometrium without organic lesions was the first,followed by benign endometrial lesions.2.The re-development of ovarian follicles is one of the causes of early vaginal bleeding after menopause.3.Postmenopausal bleeding was associated with menopausal age,FSH,E2 and endometrial lesions.