HYSTEROSCOPY IN WOMEN WITH ABNORMAL UTERINE BLEEDING ON HORMONE REPLACEMENT THERAPY - A COMPARISON WITH POSTMENOPAUSAL BLEEDING

Objective: To determine the role of outpatient diagnostic hysteroscopy in patients with abnormal uterine bleeding (AUB) on hormone replaceme nt therapy (HRT) and to contrast this with a control group of women pr esenting with postmenopausal bleeding. Design: Comparative observation al study. Setting: Outpatient hysteroscopy clinic in a university hosp ital. Patients: Three hundred ten patients undergoing outpatient hyste roscopy. Interventions: Outpatient diagnostic hysteroscopy with endome trial biopsy when indicated. Main Outcome Measures: Hysteroscopic find ings, need for cervical dilatation and local anaesthesia, correlation between hysteroscopy and histologic diagnosis. Results: There were 157 (7.1%) patients with AUB on HRT and another 153 (6.9%) with postmenop ausal bleeding out of 2,203 outpatient hysteroscopies. Hysteroscopy wa s successful in 97% and 92% of patients, respectively, and intrauterin e pathology was diagnosed in 46.7% and 39.7% of these cases. Functiona l endometrium was noted significantly more often with HRT and endometr ial atrophy with postmenopausal bleeding. Overall, local anesthesia wa s used in 126 (40.6%) and shown to be associated significantly with th e need for cervical dilatation. Endometrial biopsy was attempted in 12 5 (80%) and 119 (78%) patients in the study and control groups, but wa s unsuccessful significantly more often with postmenopausal bleeding ( 38.7% versus 16%). There were six cases of endometrial carcinoma, all in the control group. Conclusion: There is a high incidence of intraut erine abnormalities in women with menstrual symptoms while taking HRT, but the pathology differed from those with postmenopausal bleeding. A s focal lesions are found commonly in such patients, their detection b y diagnostic hysteroscopy should improve compliance with HRT as it wou ld allow individualization of treatment.