Postmenopausal Bleeding among Rural Women in Tamil Nadu, India: Mixed Methods Study

INTRODUCTION: Postmenopausal bleeding (PMB) is a common and early symptom of cervical and endometrial cancer. Its early detection can improve the cure rate and reduces mortality. OBJECTIVES: The objective of the study is to find out the prevalence and determinants of PMB in a rural community setting and the reasons for not undergoing cervical cancer screening among postmenopausal women. MATERIALS AND METHODS: A sequential exploratory mixed methods study where qualitative (group interviews) phase followed quantitative (survey) phase in the community. The survey was undertaken among the representative sample of 1,530 postmenopausal women in 34 villages of Villupuram district, Tamil Nadu. Data were collected by house-to-house survey. ANALYSIS: Bivariate and multivariate analysis was done using SPSS 24 software package. RESULTS: The prevalence of PMB was found to be 1.8%. Only 5.6% women had undergone screening. The majority did not go for screening due to lack of awareness, or they did not have any symptoms or feared about negative results. Occupation (daily wage laborers), use of oral contraceptive pills at least for 1 year, recurrent abortions (> three abortions), reproductive tract infection (more than 10 episodes in lifetime), abdominal obesity (increased waist–hip ratio), and underweight were identified as significant risk factors for PMB. CONCLUSION AND RECOMMENDATIONS: Nearly 2% of women have PMB, and most of the factors identified as determinants are preventable. Cervical cancer screening rate was poor among the respondents and lack of awareness was stated as the major reason for it. Hence, the promotion of healthy lifestyles and contraceptives in early reproductive life and awareness for the need of early screening is recommended.