The significance of “atrophic endometrium” in women with postmenopausal bleeding

Ohad Rotenberg, Gary L. Goldberg

Research output: Contribution to journalComment/debatepeer-review

2 Scopus citations


We evaluated the interpretation of atrophic endometrium (AE) histology as the most common cause for postmenopausal bleeding (PMB). This theory has been accepted for several generations by gynecologists and gynecologic oncologists and has been published in past and current major gynecology textbooks. In our review of the literature, we did not find sufficient histological or clinical proof for this concept. In our view, AE is not a cause of PMB and we back this up with a review of old and current medical literature. The old studies are based on information which was obtained prior to the existence of transvaginal sonogram, sonohysterogram and hysteroscopy. Focal lesions are notorious for being missed by endometrial sampling and curettage. Recent studies show that focal endometrial lesions are a crucial cause for PMB and some of those lesions can harbor cancer. In our opinion, AE is the most common histology found because it is physiologic and a ubiquitous finding in postmenopausal women, but it is not a cause of PMB. Referring to AE as a cause of PMB may result in misdiagnosis of cancer, management delay and unnecessary intervention. To avoid misdiagnosis of cancer, transvaginal sonogram should be considered in all women with PMB and AE on pathology. If endometrial thickness is found, AE is unlikely to be the cause of the PMB and further workup is warranted to reveal the true etiology for the bleeding.

Original languageEnglish (US)
Pages (from-to)579-583
Number of pages5
JournalArchives of Gynecology and Obstetrics
Issue number3
StatePublished - Sep 2022

ASJC Scopus subject areas

  • Obstetrics and Gynecology


Dive into the research topics of 'The significance of “atrophic endometrium” in women with postmenopausal bleeding'. Together they form a unique fingerprint.

Cite this