Abnormal uterine bleeding: an evaluation endometrial biopsy, vaginal ultrasound and outpatient hysteroscopy

Abnormal uterine bleeding is a common gynaecological symptom. Whilst most p atients have benign disease, thorough investigation is; necessary, particul arly in the peri- and post-menopausal woman. Hysteroscopy with directed bio psy of suspicious lesions is the gold standard investigation but it is inva sive and is not offered in all units as an outpatient procedure. ultrasound and outpatient biopsy techniques may allow patients to be triaged to selec t those who require formal evaluation by hysteroscopy, We assessed the records of 100 consecutive referrals to the outpatient hyst eroscopy clinic at the Royal Maternity Hospital, Belfast. In order, to deve lop a nomogram for the investigation of women with abnormal bleeding patter ns, we compared ultrasound/biopsy diagnoses with hysteroscopy/biopsy diagno sis. Pre- and peri-menopausal patients, and post-menopausal patients taking hormone replacement therapy should be investigated further if the endometr ial thickness is more than 10 mm, if endometrial biopsy is abnormal, or if symptoms are recurrent. Similarly, post-menopausal patients not taking horm one replacement therapy with an endometrial thickness of 5 mm or more shoul d be referred for hysteroscopy.