Open AccessManagement of postmenopausal bleeding in Sweden: a need for increased use of hydrosonography and hysteroscopy
Author(s) -
Epstein Elisabeth
Publication year - 2004
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/j.1600-0412.2004.00357.x
Subject(s) - hysteroscopy , medicine , endometrial biopsy , endometrium , obstetrics , postmenopausal bleeding , biopsy , gynecology , ultrasound , expectant management , radiology , endometrial cancer , pregnancy , gestation , genetics , cancer , biology
Background. The objective was to determine how postmenopausal bleeding (PMB) is managed in Sweden today, and to relate the findings to a new evidence‐based algorithm for the management of PMB. Methods. A questionnaire regarding the role of ultrasound and the use of different endometrial biopsy methods in the management of PMB was sent to all 61 gynecologic departments in Sweden. Results. Fifty‐nine of the 61 departments (97%) satisfactorily answered the questionnaire. Ultrasound was either always ( n = 54, 92%) or most commonly ( n = 5, 8%) used in the diagnostic work‐up of PMB. In women with endometrial thickness ≤4 mm, 18 of the departments (31%) routinely sampled the endometrium; 12 (15%) followed the women with ultrasound; three (5%) did both sampling and follow‐up with ultrasound; and the remaining 29 (49%) used expectant management (i.e. no biopsy or routine follow‐up). In women with endometrium ≥5 mm, hydrosonography was performed routinely in two departments (3%), occasionally in 37 departments (63%), and never in 20 departments (34%). In women with endometrium ≥5 mm, endometrial biopsy was obtained routinely by Endorette ® /Pipelle ® in 39 departments (66%), while in 26 departments (44%) operative hysteroscopy was never performed. Conclusion. More than one‐third of the gynecologic departments in Sweden never perform hydrosonography to rule out focal lesions or operative hysteroscopy for the removal of such lesions. Hydrosonography and hysteroscopy have a central role in the new guidelines for the management of PMB. Therefore, a need exists to broaden the use of hydrosonography and hysteroscopy.