Background: Postmenopausal bleeding (PMB) is a clinically important symptom associated with a significant risk of endometrial malignancy. Although transvaginal ultrasonography (TVUS) is widely used for initial evaluation, its limited specificity highlights the need for additional biomarkers to improve diagnostic accuracy. This study aimed to evaluate the association between serum estradiol levels, endometrial thickness, and histopathological characteristics in postmenopausal women with PMB and confirmed endometrial malignancy.
Methods: This retrospective cross-sectional study included 55 postmenopausal women with abnormal uterine bleeding and histopathologically confirmed endometrial cancer. Clinical, demographic, laboratory, hormonal, imaging, and pathological data were extracted from medical records. Serum estradiol levels were categorized as ≤54 pg/mL and >54 pg/mL. Endometrial thickness was assessed by transvaginal ultrasonography and classified as <4 mm or ≥4 mm. Statistical analysis was performed using SPSS version 26, and a p-value <0.05 was considered significant.
Results: The majority of patients were aged 60–69 years and obese. Most cases were endometrioid adenocarcinoma grade 1. No significant associations were observed between serum estradiol levels and age, BMI, age at menopause, interval between menopause and diagnosis, or histopathological subtype. However, a significant association was found between serum estradiol levels and endometrial thickness (P = 0.022), with all patients in the elevated estradiol group demonstrating an endometrial thickness ≥4 mm.
Conclusion: Serum estradiol levels were significantly associated with endometrial thickness but not with demographic or tumor-related characteristics. These findings suggest that estradiol may serve as a complementary biomarker alongside ultrasonographic evaluation in the risk stratification of postmenopausal women with abnormal uterine bleeding.
Implications for Patient Care: Combining serum estradiol assessment with transvaginal ultrasonography may improve risk stratification in postmenopausal women with abnormal uterine bleeding. This approach can help identify higher-risk patients for endometrial pathology, guide appropriate use of biopsy, and support conservative management in low-risk cases, enhancing individualized clinical decision-making.