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.