Spontaneous pyometra in postmenopausal women and gynecologic cancer-a preliminary study based on experience of a tertiary medical center.

OBJECTIVE

Pyometra is a rare but serious condition, particularly in postmenopausal women. While commonly linked to postpartum or post-surgical complications, spontaneous pyometra may also be associated with underlying gynecologic malignancies. We aim to examine the association between postmenopausal spontaneous pyometra (PMSP) and gynecologic cancers.

METHODS

A retrospective review of consecutive women admitted with pyometra between 2007 and 2023, at a university-affiliated tertiary medical center. Demographic and clinical data were reviewed. Women with pyometra and gynecologic cancer were compared with those without.

RESULTS

Of 231 admissions for pyometra, 47 women with PMSP were identified. The cohort was divided into a benign group (n=35, 74.4%) and malignancy group (n=12, 25.6%). Endometrial carcinoma (n=8, 67%) was the predominant malignancy, followed by cervical cancer (n=4, 33%). Although age, age at menopause, and parity showed no significant statistical differences between the groups, a higher body mass index was significantly associated with endometrial malignancy (P = 0.014). Postmenopausal bleeding as an accompanying symptom to pyometra was also more common in the malignancy group (P=0.001). The prevalence of PMSP was 1.1% for endometrial cancer and 2.2% for cervical cancer.

CONCLUSIONS

PMSP is significantly associated with gynecologic malignancies, particularly endometrial and cervical cancers. Notably, women with endometrial malignancy had a higher BMI and were more likely to present with accompanying postmenopausal bleeding. These findings suggest that in postmenopausal women presenting with spontaneous pyometra, clinicians should maintain a high index of suspicion for malignancy. Early identification and appropriate management are crucial to improving patient outcomes.