Hysteroscopy in perimenopausal and postmenopausal women with abnormal uterine bleeding

From February 1983 to January 1985, we performed outpatient microhysteroscopic examinations on 618 women 45 years of age or older with abnormal uterine bleeding (AUB). Three hundred thirty-four (54%) had normal and functional or hypoatrophic endometrium, 78 (12.6%) had low-risk hyperplasia, 8 (1.3%) had high-risk hyperplasia, and 66 (10.6%) had adenocarcinoma. Correlation with histologic findings revealed the considerable diagnostic accuracy of the technique: its reliability approaches 100% when one deals with endometrial neoplasia, 87.5% with high-risk hyperplasia and 65.2% with low-risk hyperplasia. The diagnosis cannot rely on hysteroscopic examination only. A biopsy can be performed during the examination or immediately thereafter. In 54.1% of AUB patients, no endometrial changes could be detected on hysteroscopy and biopsy. Curettage, therefore, would have resulted in overtreatment of these patients. Moreover, the usefulness of dilatation and curettage in about half of AUB patients over 45 should be questioned seriously.