Patients' preferences in the evaluation of postmenopausal bleeding

Area of Science:

• Gynecology
• Oncology
• Patient-centered care

Background:

• Postmenopausal bleeding (PMB) requires careful diagnostic management to differentiate between benign conditions and endometrial carcinoma.
• Current diagnostic pathways often begin with transvaginal ultrasound to measure endometrial thickness.

Purpose of the Study:

• To evaluate patient preferences regarding the diagnostic management of postmenopausal bleeding.
• To understand patient willingness to accept diagnostic risks versus the desire for certainty in excluding cancer.

Main Methods:

• A structured interview was conducted with 39 women who had undergone diagnostic work-up for PMB, including office hysteroscopy.
• Participants were informed about cancer probabilities and the pros and cons of various diagnostic strategies.
• Women were asked to make trade-offs between expectant management and complete diagnostic work-up.

Main Results:

• The majority of women desired 100% certainty in ruling out endometrial carcinoma.
• Only a small percentage (5%) accepted a >5% risk of false reassurance.
• If the risk of recurrent benign bleeding exceeded 25%, women preferred immediate diagnosis and treatment.

Conclusions:

• Women with PMB are willing to undergo hysteroscopy to eliminate cancer risk.
• The findings challenge the routine use of endometrial thickness measurement via transvaginal ultrasound as a primary screening tool for PMB.