1. Postmenopausal bleeding (Pmb) and benign conditions Study in rural belt of India

2. Introduction Vaginal bleeding after 6 months of amenorrhea from presumed menopause should be considered as suspicious and warrants investigations (Incidence 3%). Benign conditions though most frequent and can cause considerable distress. Study: In Gynecology department, RIMS, a rural based tertiary center (Jan’10-July’12). 51521 patients, 1200 Pmb. Aim To exclude malignancy To confirm diagnosis To treat accordingly

3. Detailed history Assessment of risk factors Full clinical examination Investigations: Routine Pap smear Appropriate biopsy Smear Cytology TVS HSG combined with TVS Saline sono-hysterography CT MRI (as required)

4. Para<=5: 513 (57 %) Low SES: 700 (78%) No circumcision: 555 (61.66%) belonging to Hindu community

6. 50-54 yrsEndometrial (Em) 50-59 yrs Endometrial (Em)

7. 50-60 yrs

8. It is mandatory and warranted to investigate every Pmb as it is the most common presenting symptom and warranting sign. 300(25%) in present study had malignant lesions. Community education, mass screening, regular follow up, timely intervention is necessary even with slight bleeding. Em. Thickness >4mm, bulky uterus considered malignant unless until proved.

9. QUESTIONS Thank you Dr Gopa Chowdhury Asstt. Prof, RIMS, Ranchi INDIA