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How should we investigate women with postmenopausal bleeding?
1Department of Obstetrics and Gynaecology, Ninewells Hospital and Medical School, Dundee, Scotland.
Acta Obstetricia Et Gynecologica Scandinavica
|May 1, 1996
Summary
Pelvic ultrasonography and outpatient endometrial sampling are recommended for investigating postmenopausal bleeding. This combined approach improves diagnosis and can reduce hospital admissions for many women.
Area of Science:
- Gynecology
- Diagnostic Imaging
- Reproductive Medicine
Background:
- Postmenopausal bleeding (PMB) necessitates accurate investigation to rule out significant pathology.
- Current diagnostic methods vary, impacting patient management and healthcare resource utilization.
Purpose of the Study:
- To determine the optimal diagnostic strategy for women presenting with postmenopausal bleeding.
- To evaluate the efficacy of pelvic ultrasonography and endometrial sampling techniques.
Main Methods:
- A prospective study involving 76 postmenopausal women with bleeding.
- All participants underwent pelvic ultrasonography, pipelle endometrial biopsy, hysteroscopy, and uterine curettage.
- Endometrial thickness measurement was a key parameter in ultrasonography.
Main Results:
- Pipelle biopsy achieved 70% success and 70% sensitivity.
- Hysteroscopy offered direct visualization and targeted biopsies.
- Endometrial thickness > 5 mm showed 83% sensitivity and 77% specificity for pathology.
- Ultrasound detected ovarian tumors, including malignancies, missed by pelvic examination.
Conclusions:
- Routine pelvic ultrasonography is crucial for excluding ovarian pathology in PMB.
- Outpatient hysteroscopy is recommended for endometrial cavity sampling and histological diagnosis.
- Combining ultrasound and outpatient endometrial sampling can potentially avoid hospital admission for over 60% of patients.