Rebleeding and endometrial growth in women with postmenopausal bleeding and endometrial thickness < 5 mm managed by dilatation and curettage or ultrasound follow-up: a randomized controlled study

Objective To compare the frequency of rebleeding and endometrial growth dur ing a 12-month follow-up period between women with postmenopausal bleeding and an endometrial thickness < 5 mm managed by dilatation and curettage, an d those managed by ultrasound follow-up. Design Consecutive women with postmenopausal bleeding and an endometrial th ickness < 5 mm were randomized to ultrasound follow-up after 3, 6, and 12 m onths (n = 48) or to primary dilatation and curettage with ultrasound follo w-up at 12 months (n = 49). At all follow-up examinations, the endometrial thickness was measured and the women were asked about rebleeding. The endom etrium was sampled at the 12-month examination, if sampling had not been pe rformed previously because of rebleeding or endometrial growth. Results Rebleeding was reported by 33% (16/48) of the women in the ultrasou nd group and by 21% (10/48)ofthose in the dilatation and curettage group (P = 0.17). Endometrial growth to ! S mm was found in 21% (10/48) of the wome n in the ultrasound group and in 10% (5/48) of those in the dilatation and curettage group (P = 0.16). No endometrial pathology was found in women wit h isolated rebleeding. Endometrial pathology during follow-up was found mor e often in women with endometrial growth than in those without (33% vs. 4%; P = 0.008). Conclusion Rebleeding and endometrial growth are common during a follow-up period of 12 months in women wit postmenopausal bleeding and an endometrial thickness < 5 mm, irrespective of whether or not dilatation and curettage is primarily carried out. If these women are managed by ultrasound follow-u p, endometrial sampling should be performed if the endometrium grows, but n ot necessarily in the case of rebleeding without endometrial growth.