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A survey of physicians' attitude towards women with postmenopausal bleeding
S Rozenberg1, S Auvertin, H Ham
1Department of Obstetrics and Gynaecology, CHU St Pierre, Free University of Brussels (ULB), rue Haute 322, B-1000, Brussels, Belgium. serge.rozenberg@skynet.be
Objective:
To study how gynaecologist manage postmenopausal bleeding in women not using HRT. The impact on the physicians' attitude of risk factors for endometrial cancer and of the endometrial thickness was essentially accounted for.
Methods:
Two different case-types were defined by modifying the risk level of developing endometrial cancer. Also the level of endometrial thickness, assessed by ultrasound, was made to vary. In total four case-types were constructed. One case-type was sent at random to each Belgian gynaecologist (n=970).
Results:
Response rate: 55%. The proportion of physicians who would not investigate the patients' endometrium varied between 2% (high-risk patient with abnormal ultrasound) and 34% (low risk patient, normal ultrasound). Significant differences were observed in relation to the level of risk factors for endometrial cancer and in relation to endometrial thickness. No significant relationship was found between the choice of the method of endometrial investigation and the risk situation or the ultrasound result.
Conclusions:
The attitude of Belgian gynaecologists towards postmenopausal bleeding is modified by the presence of risk factors and by the level of endometrium thickness. About one third of physicians would not further investigate the endometrium of a patient with a low risk profile and a normal endometrium as assessed by ultrasound.