One-stop hysteroscopy clinic for postmenopausal bleeding

To evaluate the role and feasibility of the "1-stop" clinic for management of postmenopausal bleeding, based on the use of transvaginal ultrasound and hysteroscopic examination under local anesthesia.

A retrospective analysis of 308 patients referred to the clinic between October 2000 and May 2002 was carried out. Endometrial thickness of > 4 mm, as measured by transvaginal scan, was considered the cutoff limit for further investigation by hysteroscopy.

Three hundred eight patients were seen in the 1-stop clinic. One hundred ten (35.7%) had endometrial thickness < or = 4 mm with no other associated abnormal findings and were discharged without proceeding to hysteroscopy. In 8 patients the scan was not conclusive, and they were offered hysteroscopy. Another 4 had a fluid-filled uterine cavity on sonography and were offered dilatation and curettage under general anesthesia. Eight patients opted to have the hysteroscopy done under general anesthesia, and in 12, hysteroscopyfailed under local anesthesia. Outpatient hysteroscopy was performed in 174 cases; 86 (49.4%) had normalfindings and were discharged. Endometrial polyps were found in 55 (31.6%) patients; in 42 the polyp was successfully removed at the same setting. Twenty patients (11.5%) had submucous fibroids and were discharged. A suspicious lesion was found in 13 (7.5%) patients; histologic examination confirmed endometrial carcinoma. A total of 216 of 308 (70%) patients were totally managed and discharged at the first visit with no further follow-up, and hospital admission was avoided in 258 (83.7%) of cases.

The 1-stop clinic is effective in reducing the number of hospital visits per patient as well as hospital admissions and the waiting list.