Postmenopausal bleeding (PMB) is a common gynaecological complaint with predominantly benign etiologies, though malignancies such as endometrial cancer (EC) must be excluded. This study aimed to analyse the causes of PMB and evaluate correlations between demographic, clinical, and sonographic factors with endometrial pathology. A retrospective review of 241 women presenting with PMB between January and June 2022 was conducted. After exclusions, 215 patients were analysed, including 203 who underwent endometrial biopsy. Demographic variables, body mass index (BMI), parity, comorbidities, and endometrial thickness (ET) were assessed for associations with EC, endometrial hyperplasia without atypia (EH), and atypical hyperplasia (AH). Statistical analysis employed the Mann–Whitney U, chi-square, or Fisher’s exact test as appropriate. Malignancy was diagnosed in 40 patients (18.6%), of which 28 (70%) were EC, 5 cervical carcinoma, 5 ovarian carcinoma, 1 extramammary Paget’s disease, and 1 renal cell carcinoma. Benign conditions accounted for 81.4%, with polyps being most common (29.6%). EC incidence was higher in women >60 years (28.6% vs. 6.8%, p<0.05). EC was most frequent among nulliparous and grand multiparous women, though not statistically significant. BMI ≥25 was significantly associated with EH/AH (13.7% vs. 2.7%, p=0.049). Hypertension was observed in 53.6% of EC cases, while diabetes and hyperlipidaemia were more frequent in EH/AH. ET >15 mm was strongly associated with EC (71.4%). PMB is predominantly benign, but malignancy, particularly EC, remains a significant risk. Age >60, elevated BMI, and comorbidities such as hypertension, diabetes, and hyperlipidaemia increase the likelihood of endometrial pathology. Early biopsy and diligent evaluation are critical to timely diagnosis and improved outcomes.

Dr. Ni Ni Soe is an Obstetrician and Gynaecologist with over 20 years of clinical experience. She obtained her MBBS in 1994 and a Master’s degree in Obstetrics and Gynaecology in 2003 in Myanmar. She achieved MRCOG in 2013 and was elevated to Fellow of the Royal College of Obstetricians and Gynaecologists (FRCOG) in 2025. She is a registered member of both the Myanmar Medical Council and the Singapore Medical Council. She has served as a Staff Physician at KK Women’s and Children’s Hospital. Her clinical interests focus on early pregnancy and its complications, particularly ectopic pregnancy and medical disorders in pregnancy. She has published multiple peer-reviewed papers covering topics such as ectopic pregnancy management, maternal mortality, infectious diseases in pregnancy, rare obstetric emergencies, and the wellbeing of healthcare workers during the COVID-19 pandemic. She has received numerous awards recognizing excellence in patient safety, education, service, and academic contribution, including SingHealth Gold and STAR Awards, the RISE Award, and special recognition from Lee Kong Chian School of Medicine.