Hysteroscopic evaluation of menopausal women with endometrial thickness of4 mm or more

Study Objective. To assess the diagnostic and operative potential of hyster oscopy in postmenopausal patients selected by ultrasound criteria. Design. Cohort study (Canadian Task Force classification II-2). Setting. Outpatient ultrasound and hysteroscopy department of a university- affiliate hospital. Patients, One hundred fifty-five postmenopausal women with endometrial thic kness of 4 mm or more by ultrasound, in menopause for at least 1 year, with or without menopausal complaints. Interventions, Transvaginal ultrasound a nd office hysteroscopy with eye-directed biopsy specimens using a 5-mm, con tinuous-flow, operative hysteroscope. Measurements and Main Results, Of the 155 women, 129 (83%) were asymptomati c (irregular bleeding). Hysteroscopy showed endometrial pathology in 28% of asymptomatic patients (23 polyps, 5 cases of hyperplasia, 8 submucous myom ata) and 76% of symptomatic women (13 polyps, 6 hyperplasia, 1 submucous my oma). Hysteroscopic results compared with histologic diagnosis showed a pos itive predictive value equal to 97.1% and 95% in asymptomatic and symptomat ic women, respectively and a negative predictive value equal to 100% in bot h groups. Conclusion. Office hysteroscopy with endometrial biopsy samples has a diagn ostic and operative role in post menopausal patients selected based on endo metrial thickness on ultrasound, in view of the high prevalence of endometr ial pathology in both symptomatic and asymptomatic women.