HYSTEROSCOPIC INVESTIGATION OF BLEEDING IN WOMEN RECEIVING TIBOLONE -A CASE-CONTROL STUDY

Objective To compare the hysteroscopic findings and endometrial histol ogy in women presenting with bleeding while receiving tibolone and in those with spontaneous postmenopausal bleeding (PMB). Design A retrosp ective review over a period of 1 year. Setting Outpatient hysteroscopy clinics and day surgical units, Stobhill NHS Trust, Glasgow and Leice ster Royal Infirmary NHS Trust. Subjects A total of 74 women referred for investigation of abnormal uterine bleeding; in 37 the bleeding was spontaneous and the other 37 were receiving tibolone. The average age in both groups was 55.7 years. Results Of those bleeding while receiv ing tibolone, 38% were found to have intra-uterine abnormalities on pa noramic hysteroscopy, compared with 22% in the PMB group (P=0.3). Atte mpted endometrial sampling was unsuccessful in 46% overall. There were atrophic histological findings in 89% of the tibolone group. There wa s a greater prevalence of positive findings, i.e. proliferative histol ogy and simple and atypical hyperplasia, in the PMB group (P=0.0018). Conclusion The absence of neoplasia, on endometrial sampling and panor amic hysteroscopy, is reassuring with regard to the management of wome n who are bleeding while receiving tibolone. However, investigations m ust be performed and these should always include hysteroscopy. With no tissue specimen obtained on endometrial sampling in 50% of those inve stigated, hysteroscopy is necessary to confirm normal endometrium and to identify intra-uterine abnormalities; the latter were present in ov er one-third of the tibolone group. The similar findings in the PMB gr oup were also reassuring.