Study Objective. To assess the diagnostic and operative potential of hyster
oscopy in postmenopausal patients selected by ultrasound criteria.
Design. Prospective evaluation (Canadian Task Force classification II-2).
Setting. Outpatient ultrasound and hysteroscopy department of a university-
affiliate hospital.
Patients. Two hundred twelve women with an endometrial thickness less than
4 mm on ultrasound and in menopause for at least 1 year.
Interventions. Transvaginal ultrasound and office hysteroscopy, with eye-di
rected biopsy specimens obtained with a 5-mm, continuous-flow operative hys
teroscope, and performed without anesthesia.
Measurements and Main Results. Only 13 (6%) patients were symptomatic (irre
gular bleeding). Hysteroscopic diagnosis of endometrial polyps in three wom
en (23%) was confirmed by histology. In the remaining 199 (94%) asymptomati
c patients with atrophic endometrium on ultrasound hysteroscopy showed an e
ndometrial pathology in 10% (16 polyps, 4 submucous myomas); in one patient
histologic evaluation disclosed focal adenocarcinoma in an endometrial pol
yp.
Conclusion. Hysteroscopy allows a proper histologic diagnosis, even in asym
ptomatic postmenopausal women with atrophic endometrium on ultrasound.