Vaginal ultrasonography and diagnostic hysteroscopy for women with abnormal uterine bleeding after menopause

Association of Endometrial Cancer Risk With Postmenopausal Bleeding in Women

“…The risk of endometrial cancer was significantly lower in prospective (6%; τ 2 = 0.34) and retrospective (6%; τ 2 = 0.37) studies compared with cross-sectional studies (11%; τ 2 = 0.49; P < .001 for heterogeneity) and was significantly higher in 6 studies conducted in tertiary centers (23%; 95% CI, 17%-31%; τ 2 = 0.18; P < .001 for heterogeneity), compared with studies conducted in other settings. Evidence of publication bias suggested that small studies may overestimate the risk of endometrial cancer in women with PMB (Egger regression intercept, 0.75; P = .001).…”

“…We identified 2398 studies, of which 129 were eligible for our analysis, with 40 790 unique patients, including 1 study that was eligible for both analyses (overlap of 45 women with endometrial cancers and 45 women with PMB) (eFigure 1 in the Supplement). Studies were published from January 1, 1977, through January 1, 2017, and most were cross-sectional and conducted in Northern (26 [20.2%]) and Southern Europe (24 [18.6%]).…”

“…Studies were published from January 1, 1977, through January 1, 2017, and most were cross-sectional and conducted in Northern (26 [20.2%]) and Southern Europe (24 [18.6%]). Among eligible studies, 21 were included for analysis of the prevalence of PMB in women with endometrial cancer (3792 cases of endometrial cancer, of which 3257 were in women with PMB, including the 2 studies restricted to stages III-IV cancers) and 92 were included for analysis of the risk of endometrial cancer in women with PMB (31 220 women with PMB and 2611 cases of endometrial cancer).…”

“…Study-specific and pooled estimates of the risk of endometrial cancer in women with PMB are shown in Figures 2 and 3. In 92 studies, the risk of endometrial cancer ranged from 0% to 48%, yielding an overall pooled estimate of 9% (95% CI, 8%-11%), with moderate variability observed between studies (τ 2 = 0.56).…”

“…The pooled risk of endometrial cancer was significantly higher among the 41 studies that excluded women using HT (12%; 95% CI, 9%-15%; τ 2 = 0.64) (Figure 4) compared with the 51 studies that included women using HT (7%; 95% CI, 6%-9%; τ 2 = 0.38; P < .001 for heterogeneity) (eFigure 8 in the Supplement).…”