[The value of hysteroscopy in perimenopausal women]

The aim of this review is to define clinical guidelines for the management of menopausal women with abnormal uterine bleeding. Hysteroscopy has proved to be the most accurate and reliable method for the diagnosis of intrauterine diseases. Many authors have recently proposed the use of hysteroscopy as a first line procedure in the approach to menopausal women. With continuing improvement in technology, and development of modern narrow-diameter hysteroscopes, light sources and distension-medium insufflators, hysteroscopy can now be performed as an outpatient procedure. Because of its higher diagnostic accuracy, hysteroscopy is replacing dilatation and curettage for the investigation of abnormal uterine bleeding. Diagnostic dilatation and curettage should be done with hysteroscopy to obtain visual image of the endometrial cavity and to exclude focal disease. Hysteroscopy thus turns a ,"blind" procedure into one allowing directed curettage, helps prevent missing unsuspected polypes and ensures that the most visibly abnormal areas are sampled.