Outpatient hysteroscopy for the investigation of postmenopausal bleeding

Introduction: Diagnostic hysteroscopy is the most precise procedure to eval uate diseases involving the uterine cavity. There is, however, only limited data concerning the use of hysteroscopy carried out as an outpatient proce dure in patients with postmenopausal bleeding. Materials and methods: In this study we report on 360 postmenopausal patien ts with erratic bleeding, who were referred to our outpatient hysteroscopy clinic. 185 women had frank postmenopausal bleeding (PMB) and another 175 h ad abnormal uterine bleeding while taking hormone replacement therapy (AUB) . The mean age was 57.9 years (range: 42-86). All hysteroscopies were perfo rmed using a standard 5-mm hysteroscope with a 30 degrees fore-oblique lens ; the uterine cavity was generally distended with normal saline. Results: Outpatient hysteroscopy was performed successfully in 339 patients (94.2%). In 166 cases (46.1%) cervical dilatation was neccesary, and 138 r equired (38.3%) intracervical anaesthesia. Intrauterine pathology was diagn osed in 49.6% of cases, with endometrial polyps (20.9%) and fibroids (15.9% ) being the most common abnormalities. While there was no difference in the incidence of intrauterine lesions between patients with AUB and those with PMB, endometrial carcinoma was more common in the latter group (PMB: n = 1 1 vs. AUB: n=1; p < 0.002). Conclusion: Due to its high accuracy and patient acceptance, outpatient dia gnostic hysteroscopy should become a first line investigation in postmenopa usal patients with bleeding disorders.