Abstract
Objective To establish the endometrial cancer detection rate in women
using hormone replacement therapy presenting with postmenopausal
bleeding. Design Retrospective cohort study. Setting and Population
Rapid access gynaecology clinic at a tertiary hospital. Women aged under
60 years referred with postmenopausal bleeding. Methods Retrospective
study of referrals received between 1 January 2019 and 31 December 2020
including HRT use and histological diagnosis. Main Outcome Measures
Histological diagnosis of endometrial cancer, borderline ovarian tumour
or endometrial intraepithelial neoplasia. Results 1363 women were
included. 214 women were using HRT when they experienced PMB and only
one of these had endometrial cancer at histology (cancer detection rate
0.47%). 25 of the 1124 women who were not using HRT were diagnosed with
endometrial cancer on histology (cancer detection rate 2.18%). Chi
squared statistical analysis confirmed this was statistically
significant (p value 0.0156). Conclusions The endometrial cancer
detection rate in women aged under 60 years using HRT with PMB is very
low. Referral on a two-week wait pathway for suspected cancer diagnosis
induces stress and anxiety for the woman and may lead to more invasive
initial investigation even though other diagnoses are far more likely.
Women aged under 60 years with postmenopausal bleeding that have either
commenced HRT or had a change to their preparation within the last 6
months should be seen on a less urgent referral pathway if necessary
given the very low probability of endometrial cancer. Funding None
obtained Keywords Endometrial cancer, hormone replacement therapy,
postmenopausal bleeding