The value of outpatient hysteroscopy in the management of postmenopausal bleeding: a review of 862 cases

Abstract

Objective To evaluate the efficacy, reliability and acceptability of outpatient hysteroscopy in the investigation of postmenopausal bleeding in a major teaching hospital. Design A retrospective descriptive study of 862 women referred with postmenopausal bleeding for outpatient hysteroscopy. Methods Between 1994 and 1997, 862 women were referred to the Women's Endoscopy Unit at Nottingham City Hospital for postmenopausal bleeding. Of these women, 171 were receiving hormone replacement treatment. The endocervical canal and the endometrial cavity were assessed using either a 4‐mm rigid or a 3.5‐mm flexible hysteroscope according to the preference of the operator. All hysteroscopies were performed by consultants or experienced registrars. Pipelle endometrial biopsy was taken when indicated. Results The mean age of patients referred with postmenopausal bleeding was 58 years. Hysteroscopy was completed successfully in 97.2% of all patients. Cervical stenosis and pain were the main reasons for failure to complete the procedure. Local anaesthesia with paracervical infiltration was used in one‐third of all patients undergoing hysteroscopy. Intrauterine polyps were the commonest finding (13.9%) while submucous fibroids were detected in 10.7%. Endometrial biopsies were taken in 34.7%. Abnormal histological findings were reported in 28 cases, including eight instances of endometrial adenocarcinoma. After hysteroscopic assessment, 81% of patients were discharged while further surgical treatment was warranted in 14.6%. Conclusion Outpatient hysteroscopy is a reliable, safe and well‐tolerated diagnostic procedure for investigating endometrial and endocervical pathology in patients with postmenopausal bleeding. Whenever hysteroscopic findings appear suspicious an endometrial biopsy should be taken to exclude endometrial pathology.

Prevalence of hysteroscopic findings and histologic diagnoses in patients with abnormal uterine bleeding

“…However, in relation to normal histologic diagnosis we found 8%-12% less than that found in other studies (26)(27)(28).…”

“…Nevertheless, this smaller number of normal results, in comparison with those reported in other studies, occurred with the histologic diagnosis, but not with the hysteroscopic findings (26)(27)(28). The fact that our prevalence of endometrial polyp is within the same range as that of those studies (10%-33%), suggests that there was an increase in the diagnoses of other bleeding-related pathologies.…”

Hysteroscopy as a Valid Tool for Endometrial Pathology in Patients with Postmenopausal Bleeding or Asymptomatic Patients with a Thickened Endometrium: Hysteroscopic and Histological Results

“…However, it is also useful in malignancies, in that it makes direct biopsies possible [1,6,7,13,14]. Such an examination may be conducted on outpatients, without anaesthesia, allowing in most cases a complete view of the uterine cavity.…”

“…Hysteroscopy allows a direct view of the endometrium, and biopsies are also possible [1,13,14]. It permits an accurate macroscopic diagnosis of benign lesions and their removal, allowing a ‘see and treat' approach, but histological samples must always be taken [1,15,16].…”

The value of outpatient hysteroscopy in diagnosing endometrial pathology in postmenopausal women with and without hormone replacement therapy

“…Based on our study, the relative risk of a postmenopausal woman presenting to a hysteroscopy clinic with abnormal bleeding caused by endometrial cancer is more than 10 times that of an HRT user. Two previous similar smaller studies examining hysteroscopy data failed to find a significant difference between the two groups (2,17). Importantly, in our study 13 of these cases were identified in early stages, 11 at stage I, and two at stage II; the other patient declined treatment and was not formally staged.…”