Diagnostic and therapeutic advantages of hysteroscopic surgery in management of intrauterine lesions in postmenopausal women

Study Objective. To determine the value of hysteroscopic surgery in the man agement of intrauterine lesions in postmenopausal women. Design. Descriptive study (Canadian Task Force classification II-2). Setting. Tertiary care university hospital. Patients. Fifty postmenopausal women, most with vaginal bleeding, all with intrauterine lesions (leiomyomas, polyps, adhesions) on hysteroscopy or ult rasound. Intervention. Hysteroscopic operations consisting of myomectomy, polypectom y, and adhesiolysis. Measurements and Main Results. Forty-seven procedures were completed succes sfully by hysteroscopy; partial myomectomies were performed in three women for large or deeply embedded leiomyomas. The only complication was one case of fluid overload. Median operating time was 20.0 minutes (range 5.0-60.0 min) and median postoperative hospital stay was zero days (range 0-2 days). Eight patients (16%) subsequently underwent hysterectomy, mostly for uteri ne malignancy or premalignancy. In two cases, the operative specimen includ ed malignant elements that were not evident on preoperative endometrial bio psy. During mean follow-up of 33.1 months (range 6-72 mo), 95.2% of women w ithout hysterectomy were free of symptoms. Conclusion. Hysteroscopic surgery is an effective and safe option for postm enopausal women with intrauterine lesions. It allows the correct diagnosis to be made, reduces the need for major and unnecessary surgery, and is ther apeutic in most patients.