Clinical effectiveness of hysteroscopy in abnormal uterine bleeding

The introduction of intrauterine endoscopy has allowed clinicians to evaluate an area of the body that was previously accessible only by the procedure of blind dilation and curettage (D&C). Many studies have shown hysteroscopy to be superior to D&C, yet its use has yet to be appreciated adequately. The use of hysteroscopy has been most common in the evaluation of abnormal uterine bleeding. This study showed that the most common indication for hysteroscopy was abnormal uterine bleeding (98%). Hysteroscopy was performed successfully in 91% of cases and a complete view of the uterine cavity was obtained. Intrauterine pathology was diagnosed in 60%, the highest incidence being found in those between 40 and 60 years old (80%). The presence of endometrial polyps was the most common abnormality (27.3%; n=105), and increased with age to 20% in women over 60 years. Conversely the incidence of fibroids decreased with age; only 5% in women older than 60 years. Endometrial biopsy was performed in all patients and produced adequate tissue for histological examination in 50%. Endometrial hyperplasia and carcinoma was detected in 9.9%. Sixty-three women underwent a minor hysteroscopic procedure.