# Clinical, Metabolic, and Sonographic Predictors of Endometrial Carcinoma Among Women Presenting With Postmenopausal Bleeding: A Prospective Observational Study From a Tertiary Care Center in South India

## TL;DR

This study identifies risk factors like obesity and metabolic issues that predict endometrial cancer in postmenopausal women with vaginal bleeding, using clinical and sonographic data.

## Contribution

The study provides new insights into clinical and metabolic predictors of endometrial carcinoma in postmenopausal women from a South Indian population.

## Key findings

- 17.6% of postmenopausal women with vaginal bleeding were diagnosed with endometrial malignancy.
- Obesity, diabetes with hypertension, and reproductive factors like early menarche were strongly associated with malignancy.
- All malignant cases showed endometrial thickness greater than 5 mm on sonography.

## Abstract

Background

Endometrial carcinoma represents the most common gynecological malignancy among postmenopausal women, with rising incidence attributed to increasing rates of obesity, metabolic syndrome, and changing reproductive patterns. Identifying clinical and metabolic risk factors is essential for early diagnosis and improved outcomes. This study aims to evaluate the clinical, demographic, and metabolic risk factors associated with endometrial carcinoma in postmenopausal women presenting with vaginal bleeding and to correlate bleeding patterns, endometrial thickness (ET), and histopathological findings.

Methods

This prospective observational study was conducted over 18 months at a tertiary care teaching hospital in South India. Ninety-one postmenopausal women with vaginal bleeding underwent detailed clinical evaluation, transvaginal sonography for ET assessment, and endometrial sampling for histopathological diagnosis. Demographic data, reproductive history, comorbidities, and bleeding patterns were systematically recorded. Statistical analysis was performed using the chi-square test, with a significance threshold of p < 0.05.

Results

Of the 91 women studied, 16 (17.6%) were diagnosed with endometrial malignancy, while 75 (82.4%) had benign pathology. Malignant cases were significantly associated with higher socioeconomic status, early menarche (10-12 years), late menopause (≥55 years), recurrent postmenopausal bleeding, and positive family history of malignancy. Obesity (BMI ≥30 kg/m²) and combined diabetes with hypertension showed a strong association with malignancy. All malignant cases exhibited ET >5 mm on sonography. Atypical hyperplasia and endometrioid adenocarcinoma were the predominant malignant histologies observed.

Conclusions

Obesity, metabolic syndrome, reproductive factors, and recurrent bleeding are major risk determinants for endometrial carcinoma in postmenopausal women. Integrating clinical, metabolic, and sonographic criteria can enhance early detection and risk stratification. Focused screening and prevention strategies targeting these risk factors are crucial for reducing disease burden and improving gynecologic care outcomes.