Vaginale Blutungen vor der Menopause bei gynäkologischen Malignomen

The incidence of gynaecological malignancies in pre-menopausal patients varies with age. Cervical cancer is most common in younger, premenopausal patients reaching its peak between the ages of 35 and 39 years. Vaginal carcinoma is very uncommon. Vaginal discharge and abnormal bleeding during the pre-menopause period are often the result of a clinically invasive or advanced vaginal or cervical cancer. A maximum of 25% of patients with endometrial cancer are younger than 25 years, and less than 5% are younger than 40 years. In the case of ultasonographically abnormal endometrial tissue and irregular menstrual cycles, a dilatation and curettage is necessary. The diagnosis of endometrial cancer is often based of the finding of atypical hyperplasia of the endometrium. In pre-menopausal patients about 3–7% of ovarian tumors are malignant. Abnormal menstrual bleeding may occur in patients with epithelial ovarian cancer or hormone secreting tumors of the ovary. All malign genital diseases may be responsible for abnormal vaginal bleeding or disorders of menstrual cycle. For this reason, clinical examination, including coloscopy and ultrasound of uterus and appendages, is necessary to rule out a malignancy. Vaginal bleeding after birth or abortion with increased β-HCG levels may be the result of remaining trophoblast tissue and dilatation and curettage are necessary. Curettage also eliminates the possibility of choriocarcinoma.