Open AccessHow should we investigate women with postmenopausal bleeding?
Author(s) -
Gupta Janesh Kumar,
Wilson Sheena,
Desai Pershant,
Hau Cathy
Publication year - 1996
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 - 10.3109/00016349609033357
Subject(s) - medicine , endometrial biopsy , hysteroscopy , curettage , uterine cavity , outpatient clinic , biopsy , postmenopausal bleeding , gynecology , sampling (signal processing) , obstetrics , radiology , prospective cohort study , uterus , surgery , endometrial cancer , cancer , filter (signal processing) , computer science , computer vision
Objective. To evaluate the optimum method(s) of investigating women with postmenopausal bleeding. Design. Prospective study of 76 postmenopausal women. Setting. Teaching Hospital. Interventions. All women had pipelle endometrial biopsy in outpatient clinic. Prior to inpatient hysteroscopy and uterine curettage, each woman had pelvic ultrasonography to measure the endometrial thickness and to exclude ovarian pathology. Results. Pipelle biopsy was successful in 70% of cases and has a sensitivity of 70%. Hysteroscopy has superior diagnostic capabilities allowing direct visualisation of the endometrial cavity with directed biopsies. Endometrial thickness of >5 mm used as an indicator of endometrial pathology compared to uterine curettage has a sensitivity of 83%, a specificity of 77%, and a positive predictive value of 54%. Ultrasound also detected five ovarian tumors, two of which were malignant and three missed by pelvic examination alone. Conclusions. We recommend the routine use of pelvic ultrasonography in all women with postmenopausal bleeding as it is an invaluable diagnostic tool in excluding ovarian pathology. In addition, sampling of the endometrial cavity, preferably with outpatient hysteroscopy, is mandatory for histological diagnosis. Overall, the combination of ultrasound and outpatient endometrial sampling would spare hospital admission for at least 60% of women with postmenopausal bleeding.