Irregular perimenopausal bleeding as a 'red flag'

Irregular bleeding is common in perimenopausal women, but results of a new study indicate that it isn’t strongly associated with uterine cancer. The findings, published in The British Journal of Obstetrics and Gynaecology, may be helpful to ob/gyns in counseling women at midlife about whether to seek medical attention for intermenstrual and postcoital bleeding.

Data included in the prospective cohort study were from women aged 40 to 54 years seen at 7 general practices. The goal of the research was to estimate rates of occurrence and spontaneous resolution of intermenstrual and postcoital bleeding during perimenopause and to assess potential linkage with cancer.

Questionnaires were sent to 7,121 women at baseline and then at 6, 12, 18, and 24 months. Medical records were reviewed from baseline to 48 months. Overall, 66% of the patients responded to the questionnaires and information was collected from 2,104 menstruating women.

Over the 2-year study period, cumulative incidence of intermenstrual bleeding was 24% (95% CI 21%-27% (confidence interval [CI] 21%-27%) and of postcoital bleeding was 7.7% (95% CI 6.2%-9.5%). Rates of spontaneous resolution without recurrence over the same period were 37% (95% CI 29-45) and 51% (95% CI 40-62) for the two types of bleeding, respectively. Only 1 of 785 women who had intermenstrual and/or postcoital bleeding developed uterine cancer.

The authors believe that their study represents “the first published estimates of the likelihood that perimenopausal women in the community will develop and have resolution of intermenstrual and postcoital bleeding with no treatment.” The results, they said, suggest that “the predictive value of these symptoms for uterine malignancy in this age group in community populations is poor.”