HYSTEROSCOPIC SURGERY FOR THE TREATMENT OF PERSISTENT POSTMENOPAUSAL BLEEDING

OBJECTIVES: Determine the effectiveness of hysteroscopic surgery in pe rsistent postmenopausal bleeding. PATIENTS AND METHODS: Transcervical resection was performed in 176 women between the ages of 46-74 years. A benign cause was noted in 135 cases (polyps in 80 and submucous fibr oids in 55); 37 patients had no significant disease and 4 had endometr ial atypical hyperplasia missed in the preoperative evaluation. Patien ts underwent resection of polyp, resection of fibroid or endometrial a blation. Major operative complications were rare and included 3 perfor ations and one case of fluid overload. Patients were followed for 1-10 years after treatment (mean follow-up 52 months). RESULTS: 167 patien ts completed the study. Clinical manifestations disappeared in 85.2% o f the patients; 15 patients had hysterectomy after the hysteroscopic p rocedure and 11 had repeat transcervical resection. CONCLUSION: Hyster oscopic treatment can be effective in carefully selected patients with postmenopausal bleeding or abnormal uterine bleeding on hormone repla cement therapy. The operative criteria should take the causes of bleed ing and not just the age of patient into account