Comparison of Endorette (R) and dilatation and curettage for sampling of the endometrium women with postmenopausal bleeding

Main question. To compare the diagnostic properties of Endorette(R) and D&C in women with postmenopausal bleeding, to relate the properties to endomet rial thickness as measured by ultrasound, and to assess the women's experie nces of the two methods. Methods. In a prospective study, 133 consecutive women with postmenopausal bleeding were examined with transvaginal ultrasound. After measuring the en dometrial thickness, Endorette(R) sampling was performed without anesthesia . Dilatation and curettage (D&C) was carried out under general anesthesia w ithin six weeks. After completion of each sampling procedure the women fill ed in a questionnaire regarding their experience of the sampling. Results. Endorette(R) sampling failed in 16% (21/133) of the women. More th an half (56%) of the women experienced moderate or strong pain during Endor ette(R) sampling, and the doctor underestimated the pain in 62% of the wome n. Endorette(R) failed to diagnose two of seven (29%) endometrial cancers f ound at D&C. In one of these two cases, the examiner suspected that the End orette(R) device had not reached the uterine fundus. In women with endometr ium <7 mm, Endorette(R) and D&C showed similar results with regard to obtai ning a sufficient endometrial sample and to distinguishing normal endometri um, benign pathological endometrium. and malignancy. In women with endometr ium <greater than or equal to>7 mm, Endorette(R) yielded insufficient sampl es significantly more often than D&C (23% vs 6%, p=0.02; the McNemar test) and missed all polyps and most (77%) hyperplasias diagnosed by D&C. Conclusion. Endorette(R) and D&C have similar diagnostic properties in wome n with postmenopausal bleeding and endometrium. <7 nim. D&C is superior to Endorette(R) in women with endometrium <greater than or equal to>7 mm.