The feasibility of a 'one stop' ultrasound-based clinic for the diagnosis and management of abnormal uterine bleeding

Objectives We have established a 'one stop' clinic for the management of wo men with abnormal uterine bleeding based on transvaginal sonography and sal ine contrast sonohysterography. This report reviews our experience with the first 93 patients attending the clinic. Design and methods Patients were seen with the intention of performing a tr ansvaginal scan, saline contrast sonohysterography, endometrial biopsy, ful l blood count and thyroid function tests. The findings were prospectively r ecorded on a computer database and a management plan formulated. Results A transvaginal scan was performed on 89 (95.7%) women, 70 (75.3 %) also undergoing saline contrast sono-hysterography. An endometrial biopsy w as carried out in 67 (72 %) women aged 40 years and above, and 79 (84.9%) h ad blood tests. The median age of patients was 44 (range, 21-78) years. The majority of women presented with menstrual disorders. Uterine pathology wa s detected on transvaginal scan in 42 (47.2%) cases. Adnexal pathology was detected in 12 (13.5%) of the patients. Endometrial biopsy detected three ( 4.5%) cares of endometrial a typia, and three (4.5 %) cases of adenocarcino ma. A hemoglobin level of < 10 g/dL was detected in 3 (3.4%) patients. A si ngle clinic visit was thought sufficient for 83 (89.2%) women. Medical ther apy was started in 47 (50.5%) patients, 15 (16.3%) were brought back for in patient diagnostic hysteroscopy, and nine (9.7%) were booked for operative endoscopy, while six (6.5%) had conventional surgery; the remainder were re assured. Conclusions This study demonstrates that a 'one stop' manage ment philosoph y based on pelvic ultrasound is feasible. Our data suggest that diagnostic hysteroscopy can be decreased using this approach, and challenge the use of hysteroscopy its the first stage test.