Outcome of outpatient micro-hysteroscopy performed for abnormal bleeding while on hormone replacement therapy

This retrospective observational study was carried out in a large district general hospital to review the outcome of outpatient micro-hysteroscopy performed on women with abnormal bleeding while on hormone replacement therapy. All women referred to the outpatient hysteroscopy unit with abnormal bleeding while on hormone replacement therapy between November 1994 and August 1998 had hysteroscopy performed using a 1.2 mm semi-rigid hysteroscope with a 2.5 mm sheath. Hysteroscopy was performed on 190 women. Ninety-two women (48.4%) had a normal uterine cavity, 38 (20%) had an atrophic endometrium, 52 (27.4%) were found to have endometrial polyps, seven (3.7%) had suspicious endometrium (histology showed two adenocarcinomas and three hyperplasias) and one patient (0.5%) had a submucous fibroid. Histological evaluation showed 145 (76.32%) specimens were benign, 37 (19.47%) specimens either contained no tissue or insufficient tissue for diagnosis, five (2.63%) showed hyperplasia and three (1.58%) were adenocarcinoma. Two hyperplasias and one focal adenocarcinoma were diagnosed in endometrial polyps. Nearly half of the women who had a hysteroscopy for abnormal bleeding while on hormone replacement therapy had a normal endometrial cavity. Almost one-third had endometrial pathology, of which the majority were endometrial polyps. The incidence of endometrial carcinoma was low. No abnormality was missed on hysteroscopy, but histology was normal in two patients with hysteroscopically suspicious endometrium.