Abnormal Uterine Bleeding and Cancer of the Genital Tract

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Abstract
EDITORIAL COMMENT: This paper makes the point that dilatation and curettage need not be routinely performed in women under the age of 40 years with menor‐rhagia to exclude carcinoma of the endometrium. This point is worth making since many such operations are done for this indication. However, dilatation and curettage may be indicated in women under the age of 40 when excessive menstrual bleeding is causing anaemia, is associated with pain, or palpable gynaecological pathology. Presumably there were a number of patients in this study with menor‐rhagia, aged less than 40 years, in whom atypical hyperplasia of the endometrium was diagnosed as a result of dilatation and curettage and/or hysterectomy. The patients with menorrhagia included 195 with endometrial hyperplasia and 86 with endometrial polyps — one would imagine that a number of these women, even some under the age of 40, had their proper further management determined by knowledge of their endometrial histology! Summary: All patients in Tasmania admitted to hospital for investigation of abnormal uterine bleeding in 1987 and 1988 were studied. A total of 4,318 patients were investigated. Four of 539 (0.7%) patients with intermenstrual or postcoital bleeding and 31 of 538 (5.8%) patients with postmenopausal bleeding were found to have endometrial cancer. Of the 3,241 patients investigated for ‘heavy’ periods (menorrhagia) there was no case of endometrial cancer. The detection rate of endometrial cancer on dilatation and curettage before the menopause is extremely low. Patients presenting with menorrhagia should not be treated surgically in the first instance unless an obvious organic cause is present.

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