Rebleeding and endometrial growth in women with postmenopausal bleeding and endometrial thickness <5 mm managed by dilatation and curettage or ultrasound follow‐up: a randomized controlled study

Objective To compare the frequency of rebleeding and endometrial growth during a 12‐month follow‐up period between women with postmenopausal bleeding and an endometrial thickness < 5 mm managed by dilatation and curettage, and those managed by ultrasound follow‐up. Design Consecutive women with postmenopausal bleeding and an endometrial thickness < 5 mm were randomized to ultrasound follow‐up after 3, 6, and 12 months ( n = 48) or to primary dilatation and curettage with ultrasound follow‐up at 12 months ( n = 49). At all follow‐up examinations, the endometrial thickness was measured and the women were asked about rebleeding. The endometrium was sampled at the 12‐month examination, if sampling had not been performed previously because of rebleeding or endometrial growth. Results Rebleeding was reported by 33% (16/48) of the women in the ultrasound group and by 21% (10/48) of those in the dilatation and curettage group ( P = 0.17). Endometrial growth to ≥ 5 mm was found in 21% (10/48) of the women in the ultrasound group and in 10% (5/48) of those in the dilatation and curettage group ( P = 0.16). No endometrial pathology was found in women with isolated rebleeding. Endometrial pathology during follow‐up was found more often in women with endometrial growth than in those without (33% vs. 4%; P = 0.008). Conclusion Rebleeding and endometrial growth are common during a follow‐up period of 12 months in women with postmenopausal bleeding and an endometrial thickness < 5 mm, irrespective of whether or not dilatation and curettage is primarily carried out. If these women are managed by ultrasound follow‐up, endometrial sampling should be performed if the endometrium grows, but not necessarily in the case of rebleeding without endometrial growth. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology