[Hysteroscopy in cases of benign intrauterine formations in the postmenopause]

Submucous myomas and especially endometrial polyps are often found in the postmenopause. There are no reliable clinical or ultrasound criteria to predict their malignancy potential. The D&C is insufficient diagnostic and therapeutic method in case of benign intrauterine formations. The potentialities of the hysteroscopy make it a particularly appropriate method in these cases.

The aim of the research is to estimate the results of the applying of the hysteroscopy in the postmenopause for diagnosis and treatment of the benign intrauterine formations.

The research included 62 women in postmenopause with bleeding, pains or sonographically-found formations in the intrauterine cavity. Their age varied from 50 to 78 years and 62.3% of women were over 55 years. Thirty patients suffered from serious concomitant illnesses. Seventeen of the women had already undergone one or more D&C.

Hysteroscopy with resection of the formations was performed in all of the cases. Eighty formations have been evacuated--18 submucous myomas and 62 endometrial polyps. The average size of the submucous myomas was 24.0 mm (from 5 to 70 mm). The average operational time in the cases of endometrial polyps was 15.2 min. (from 5 to 50 min) and 18.3 min. (from 10 to 40 min.)--in the cases of submucous myomas. Intraoperational complications developed in two of the cases (heavy bleeding and perforation). Forty nine patients have been observed postoperatively. Out of 14 women with submucous myomas 10 have been observed and all of them had no complaints or recurrences. Thirty nine out of 48 women with endometrial polyps have been observed and 36 of them had no complaints or indications of a recurrence. In one case a new polyp was found after two years and a new hysteroresection was performed. Two women underwent hysterectomy subsequently because of bleeding and endometrial hyperplasia.

The hysteroscopic polypectomy is an effective and harmless procedure. It gives the possibility that the object be seen, localized, sampled and evacuated entirely. The approach is miniinvasive, the general anesthesia and laparotomy is avoided. This is especially important for women with serious concomitant diseases. A histological examination of the whole formation is possible.

Hysteroscopy is the most appropriate modern method for diagnosis and treatment of benign intrauterine formations in the postmenopause.