Hysteroscopic evaluation of menopausal women with endometrial thickness of 4 mm or more
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Published on: August 2, 2024
V Loizzi1, S Bettocchi, A Vimercati
1II Clinica Ostetrica e Ginecologica Policlinico, Piazza Giulio Cesare 11, 70125 Bari, Italy.
Study Objective:
To assess the diagnostic and operative potential of hysteroscopy in postmenopausal patients selected by ultrasound criteria.
Design:
Cohort study (Canadian Task Force classification II-2).
Setting:
Outpatient ultrasound and hysteroscopy department of a university-affiliated hospital.
Patients:
One hundred fifty-five postmenopausal women with endometrial thickness of 4 mm or more by ultrasound, in menopause for at least 1 year, with or without menopausal complaints.
Interventions:
Transvaginal ultrasound and office hysteroscopy with eye-directed biopsy specimens using a 5-mm, continuous-flow, operative hysteroscope.
Measurements And Main Results:
Of the 155 women, 129 (83%) were asymptomatic (irregular bleeding). Hysteroscopy showed endometrial pathology in 28% of asymptomatic patients (23 polyps, 5 cases of hyperplasia, 8 submucous myomata) and 76% of symptomatic women (13 polyps, 6 hyperplasia, 1 submucous myoma). Hysteroscopic results compared with histologic diagnosis showed a positive predictive value equal to 97. 1% and 95% in asymptomatic and symptomatic women, respectively, and a negative predictive value equal to 100% in both groups.
Conclusion:
Office hysteroscopy with endometrial biopsy samples has a diagnostic and operative role in postmenopausal patients selected based on endometrial thickness on ultrasound, in view of the high prevalence of endometrial pathology in both symptomatic and asymptomatic women.
