A Review on the Outcome of Patient Managed in One Stop Postmenopausal Bleeding Clinic in New Territories East Cluster, NTEC
Conditions: Postmenopausal Bleeding
Sponsor: Chinese University of Hong Kong

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Date: 24 Jul 2017 
 
 
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A Review on the Outcome of Patient managed in One Stop Postmenopausal 
Bleeding Clinic in New Territories East Cluster, NTEC 
 
Principal Investigator:  Dr. CHEUNG Chun Wai 
Co-investigators:  
Dr. FUNG Wen Ying, Linda 
 
 
 
Dr. CHAN Wai Yin, Winnie   
 
 
 
Prof.  Lao Tzu Hsi, Terence  
Department of Obstetrics and Gynaecology, the Chinese University of Hong Kong, Shatin, New 
Territories, Hong Kong. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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Date: 24 Jul 2017 
 
 
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Introduction: 
Postmenopausal bleeding (PMB) is a common gynaecological complaint, accounting for up to 5 to 10 % 
of postmenopausal women being referred to gynaecological outpatient clinic (1, 2).  It also comprised of 
up to 10% of our outpatient gynaecological referral.   In general, 60 % of women with postmenopausal 
bleeding have no organic causes identified, whilst benign causes of PMB includes  atrophic vaginitis, 
endometrial polyp, submucosal fibroid and functional endometrium.  However, between 5.7 to 11.5% of 
women with postmenopausal bleeding have endometrial carcinoma (3, 4, 5), which is the fourth most 
common cancer among women (6),  therefore, it is important to investigate carefully to exclude genital 
tract cancer.  
In the past, often women with PMB require multiple clinic visits in order to reach a final diagnosis.  This 
not only increase the medical cost as a whole, but also imposes an enormous stress and burden on 
patients, concerning about delayed or overlooked diagnosis of genital tract cancer.   
A One-stop postmenopausal bleeding clinic has been established since February, 2002 by the 
Department of Obstetrics and Gynaecology, New Territories East cluster (NTEC) aiming at providing 
immediate assessment of women with postmenopausal bleeding in one single outpatient clinic 
assessment.   
During the visit, a detailed history was taken in regarding the PMB and usage of hormonal replacement 
therapy or herbal medicine.  A physical examination was performed and a cervical smear was taken if 
not been taken within a year.  Transvaginal ultrasound (TVS) was then performed to measure the 
endometrial thickness (ET), examining ovaries then followed by an endometrial sampling.  An outpatient 
hysteroscopy was performed only if TVS showed an ET >= 5mm, or an abnormal endometrial 
appearance or unsatisfactory ET. Benign looking endometrial polyp would be removed during the 
outpatient hysteroscopy if possible.  
 At the moment, there was very limited local data (7, 8) and lack of the long term result.  We aim to 
retrospectively evaluate the clinical outcome of postmenopausal bleeding patients who has attended 
One Stop Postmenopausal Clinic in order to formulate better care and counseling in future.  
 
Objectives:  
1. To analyze histopathology in relative to history and ultrasound findings in PMB women 
presented to  One Stop Postmenopausal Bleeding Clinic  at NTEC  
2. To correlate  the clinical findings of transvaginal ultrasonography ( TVS) with outpatient 
hysteroscopy and endometrial assessment in The One Stop Postmenopausal Bleeding Clinic  
3. To identify predictive and prognostic factors in women with PMB for possible use in triaging high 
risk patients  
 

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Date: 24 Jul 2017 
 
 
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Methodology 
A. Subjects 
Postmenopausal women who attended the One Stop Postmenopausal Bleeding Clinic since year 2002 
B. Methods 
All women with postmenopausal bleeding presented to One-Stop PMB clinic were enrolled for analysis.  
Menopause was defined as the cessation of menses for more than 1 year.  These patients had a 
thorough history taken.  A physical examination was performed. A vaginal ultrasound was performed to 
determine uterine dimension, the endometrial thickness (ET) and exclude other adnexal pathology.  An 
Endometrial sampling was taken afterward.   An outpatient hysteroscopy , a 2.7mm or 2mm 30 degree 
rigid hysteroscope was then inserted into the uterine cavity using either CO2 or normal saline as 
distending medium to identify uterine pathology  if TVS showed an ET >= 5mm, or an abnormal 
endometrial appearance, or unsatisfactory ET.   Benign looking endometrial polyps were removed 
during the outpatient hysteroscopy if possible.  The management was determined by the finding on 
transvaginal ultrasonography and hysteroscopy.  If surgery was indicated, appropriate surgery would be 
booked in the clinic.   Patient was discharged from the clinic if the findings were normal. A call-back 
system was established to recall patients with abnormal pathology.   A follow up appointment would be 
given in case of suspicious pathology or incomplete examination.   
The data was transferred into a computer database which will be analyzed.  Medical records of all 
patients who presented to our One- Stop clinic at New Territories East Cluster will be reviewed. Patient’s 
demographic data, presenting symptoms, clinical assessments, investigations and treatments will be 
collected.  If they had operations performed, surgical pathology, if any, will also be reviewed.   The 
outcomes in terms of death or still being alive are also ascertained from the Computerized Medical 
System.  
 
Data and Analysis 
Data will be analysed using SPSS 22.0 (SPSS Inc., Chicago, IL, USA) program. For comparison of 
frequencies, chi-square test or or a two-sided Fishers’ exact test will be used where appropriate. The 
Mann- Whitney U Test will be used to compare nonparametric data and the Kolmogorov-Smirnov test 
for correlation analysis with P<0.05 as indication of significance.   
 
 

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Date: 24 Jul 2017 
 
 
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Implication of Data 
Postmenopausal bleeding (PMB) is a worrisome symptom that requires urgent investigation because of 
its association with genital tract malignancy.   One-stop postmenopausal bleeding clinic is becoming a 
trend, which has been effective in reducing the number of hospital visits per patient as well as 
decreasing patient anxiety (9).   The review of the results of our One Stop Clinic which allows us to have 
better understanding of our patient’s characteristics, risk factors and underlying pathologies in causing 
PMB. These could provide a better local evidence for future clinical use and patient care.   The data 
helps to provide the basis for further improvement and streamlining the service as well as finding new 
approaches in the organization of the service. 
 
Reference  
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Investigation of women with postmenopausal uterine 
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practice 
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4.  Gredmark T, Kvint S, Havel G, Mattsson LA.   Histopathological findings in women with 
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6.  Top 10 cancers, Hong Kong Cancer Registry, Hospital Authority 
 
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