The Value of Diagnostic Hysteroscopy before Operative Hysteroscopy for Suspected Abnormal Intrauterine Findings

Study ObjectiveTo evaluate the accuracy of diagnostic office hysteroscopy in the detection of abnormal uterine findings in symptomatic and asymptomatic patients and compare it with the accuracy of operative hysteroscopy.DesignA retrospective analysis of all women after operative hysteroscopy between 2010 and 2012 in our institution (Canadian Task Force classification II-2).SettingThe department of gynecology in a tertiary referral medical center.PatientsOne hundred thirty-two patients with a mean age of 48 years after diagnostic office hysteroscopy and subsequent operative hysteroscopy.InterventionsOperative hysteroscopy.Measurements and Main ResultsWe collected demographic and clinical data from patients' charts. The indications as well as findings of the previous diagnostic modality (transvaginal ultrasound [TVUS] and diagnostic hysteroscopy) were gathered and compared with the final tissue diagnosis obtained via operative hysteroscopy. Positive predictive values in diagnostic hysteroscopy were calculated for common pathological intrauterine findings. Forty-eight patients (37%) were menopausal, and 84 (63%) were premenopausal. The indications for hysteroscopy were abnormal uterine bleeding in 46% of patients and suspected uterine finding in 44%. A TVUS preceded the diagnostic hysteroscopy in 105 women (80%). Older female age, menopausal status, and abnormal intrauterine findings larger than 15 mm were associated with significantly greater true-positive rates on diagnostic hysteroscopy (i.e., the suspected findings on diagnostic hysteroscopy were verified by final pathology). Uterine bleeding during the interval between procedures was marginally significant and associated with greater false-positive results. Bleeding as opposed to routine evaluation of uterine cavity, interval between procedures, location of intrauterine finding, and hormone replacement therapy were not associated with greater true-positive values.ConclusionAlthough diagnostic hysteroscopy is superior to TVUS in the assessment of polyps, it contributes little to TVUS when myomas and endometrial hyperplasia are suspected. Therefore, it should not be used routinely as an interface between TVUS and operative hysteroscopy when such findings such are suspected. Furthermore, in premenopausal patients with abnormal uterine bleeding between diagnostic and operative procedures and when small (<15 mm) polyps are suspected, it might be worthwhile to repeat a diagnostic procedure before operative hysteroscopy.     

Six thousand office diagnostic-operative hysteroscopies.

OBJECTIVE: To compare CO(2) and normal saline as distention media in office diagnostic hysteroscopy. METHODS: The outcome of more than 6000 office hysteroscopies was analyzed. We used carbon dioxide or saline as distension medium. Minor hysteroscopic techniques were performed when indicated. RESULTS: The major indication was abnormal uterine bleeding (45%). Satisfactory hysteroscopy was achieved in 92. 4% with CO(2) and in 98.3% with saline (P<0.05). Local anesthesia was used in 54 patients (1.5%) with CO(2) and in three patients (0. 1%) with saline (P<0.001). Four hundred and two women (16.3%) underwent hysteroscopic procedures under saline hysteroscopy. Endometrial polyps were removed in 281 patients, 75 IUDs were removed, 14 fibroids were extracted, uterine septa were excised in 11 cases and mild and moderate adhesions were transected in 21 patients. CONCLUSION: Saline office diagnostic hysteroscopy offers at least all the advantages of the CO(2) hysteroscopy, and gives the possibility to easily 'find and treat in situ' many of the lesions observed.     

Low-dose spinal anesthesia with hyperbaric bupivacaine with intrathecal fentanyl for operative hysteroscopy: a case series study

Study ObjectiveTo estimate the efficacy and tolerability of low dose spinal anesthesia during operative hysteroscopy in a group of patients with high surgical risks.DesignCase series study (Canadian Task Force Classification II-2).SettingTertiary centers for women health care.PatientsA total of 47 women affected by endometrial polyps (n = 32), myomas (n = 8), and abnormal uterine bleeding (n = 7) scheduled for inpatient operative hysteroscopy.InterventionsTransvaginal ultrasonography; office diagnostic hysteroscopy; preoperative evaluation of American Society of Anesthesiologist (ASA) classification; inpatient operative hysteroscopy; low-dose spinal anesthesia with hyperbaric bupivacaine; compilation of a questionnaire.Main Outcome MeasuresPracticability and patients’ subjective experiences with spinal anesthesia; duration of cervical dilation and for operative hysteroscopy; infusion volume needed; incidence of surgical complications.ResultsResectoscopy was performed in all patients, with the exception of 1 woman (2.1%) in which spinal anesthesia was unsuccessful. No statistically significant differences were noted among groups in terms of intra- and peri-operative findings. Sensory block induced by spinal anesthesia was suitable for surgery in all patients, and side effects occurred far less frequently than mentioned in the literature. Data reported in the questionnaire revealed that 93.5% of women would choose a spinal anesthesia again for a potential operative hysteroscopy in the future, since for 89.1% of them long lasting anesthesia is of relevance.ConclusionsLow-dose spinal anesthesia is a feasible technique in the inpatient setting for operative hysteroscopy in women with high surgical risks.     

Bipolar electrical energy in physiologic solution--a revolution in operative hysteroscopy

STUDY OBJECTIVE: To evaluate the feasibility and efficiency of operative hysteroscopy in physiologic saline solution. DESIGN: Prospective observational study (Canadian Task Force classification II-2). SETTING: Tertiary university hospital. PATIENTS: One hundred sixteen women (56% menopausal) with intrauterine pathology with or without symptoms, in whom malignancy was excluded by endometrial sampling. INTERVENTION: Operative hysteroscopy for resection of uterine septa, lysis of adhesions, and resection of myomas or polyps using a bipolar electrical energy system (VersaPoint) developed for this purpose. MEASUREMENTS AND MAIN RESULTS: Polyps were significantly more common in menopausal than in premenopausal women. Symptoms (mainly bleeding) occurred in 66.9% of premenopausal and 74.5% of menopausal patients. Endometrial polyps and submucous myomata were associated with symptoms in 68% and 70%, respectively. Operating time was less than 25 minutes. Two specimens revealed malignancy. One uncomplicated uterine perforation occurred. CONCLUSION: This new technique has the potential to replace monopolar-based intrauterine interventions and may become the treatment of choice for benign intrauterine pathology.     

Technology assessment of saline contrast hysterosonography

OBJECTIVE: The purpose of our study was to evaluate to which extent saline contrast hysterosonography (SCHS) is able to replace diagnostic hysteroscopy in uterine cavity evaluation in women suspected of intrauterine abnormalities. STUDY DESIGN: In this prospective observational study we performed SCHS instead of diagnostic hysteroscopy. Diagnostic hysteroscopy was performed in case of failed or inconclusive SCHS. Univariate and multivariate analyses were used to assess subgroups for their risk of failure and inconclusiveness. RESULTS: Two hundred fourteen women were included consecutively. SCHS was conclusive in 180 cases (84.1%), failed in 12 (5.6%), and inconclusive in 22 (10.3%). Uterine size above 600 cm(3) was the best predictor of failure and/or inconclusiveness (positive predictive value 0.42). CONCLUSION: SCHS was able to replace 84% of the outpatient diagnostic hysteroscopies in uterine cavity evaluation in women suspected of intrauterine abnormalities. Our study showed that diagnostic hysteroscopy can be restricted to inconclusive or failed SCHS.     

A randomised comparison of vaginoscopic office hysteroscopy and saline infusion sonography: a patient compliance study

Objective  The purpose of this study was to compare patient discomfort during saline infusion sonography (SIS) and office hysteroscopy performed according to a vaginoscopic approach.
Design  Randomised controlled trial.
Setting  University hospital.
Population  Women with an indication for further investigation of the uterine cavity.
Methods  A total of 100 women randomly allocated to either SIS or vaginoscopic office hysteroscopy in an outpatient clinic.
Main outcome measures  Scores on a visual analogue scale (VAS) for pain and a present pain intensity (PPI) scale, conclusiveness and success rate.
Results  The patients' pain scores on both the VAS and the PPI were lower for SIS when compared with office hysteroscopy ( P < 0.05). However, in cases of severe pain (VAS > 7 or PPI > 2), there was no statistically significant difference between both groups. The success rate, defined as adequate inspection of the cervical canal and uterine cavity, was 94% for SIS compared with 92% for office hysteroscopy ( P = 0.633). SIS, multiparity, shorter procedure time and position of the uterus in anteversion decreased pain scores among women studied.
Conclusions  Both SIS and office hysteroscopy are successful procedures and well tolerated by women. SIS induces significantly less discomfort than office hysteroscopy and should therefore be considered the method of choice.     

Hysteroscopic evaluation of menopausal women with endometrial thickness of 4 mm or more

STUDY OBJECTIVE: To assess the diagnostic and operative potential of hysteroscopy in postmenopausal patients selected by ultrasound criteria. DESIGN: Cohort study (Canadian Task Force classification II-2). SETTING: Outpatient ultrasound and hysteroscopy department of a university-affiliated hospital. PATIENTS: One hundred fifty-five postmenopausal women with endometrial thickness of 4 mm or more by ultrasound, in menopause for at least 1 year, with or without menopausal complaints. INTERVENTIONS: Transvaginal ultrasound and office hysteroscopy with eye-directed biopsy specimens using a 5-mm, continuous-flow, operative hysteroscope. MEASUREMENTS AND MAIN RESULTS: Of the 155 women, 129 (83%) were asymptomatic (irregular bleeding). Hysteroscopy showed endometrial pathology in 28% of asymptomatic patients (23 polyps, 5 cases of hyperplasia, 8 submucous myomata) and 76% of symptomatic women (13 polyps, 6 hyperplasia, 1 submucous myoma). Hysteroscopic results compared with histologic diagnosis showed a positive predictive value equal to 97. 1% and 95% in asymptomatic and symptomatic women, respectively, and a negative predictive value equal to 100% in both groups. CONCLUSION: Office hysteroscopy with endometrial biopsy samples has a diagnostic and operative role in postmenopausal patients selected based on endometrial thickness on ultrasound, in view of the high prevalence of endometrial pathology in both symptomatic and asymptomatic women.     

Routine office hysteroscopy prior to ICSI and its impact on assisted reproduction program outcome: A randomized controlled trial

ObjectiveTo assess the incidence of undiagnosed intrauterine pathology based on screening office hysteroscopy in women with normal hysterosalpingogram (HSG) and/or transvaginal ultrasonograghy (TVS), and their impact on the success rate of ICSI (intracytoplasmic sperm injection).DesignRandomized controlled trial.SettingIn El-Menya Infertility Research and Treatment Center (MIRTC), El-Menya, Egypt.Patient(s)Two hundred and forty consenting patients were eligible to participate in the study, who further randomized into two equal groups, 120 patients in group I (ICSI without office hysteroscopy), and 120 patients in group II (had ICSI after office hysteroscopy). Only 110 and 105 patients completed the study in group I and group II, respectively.Intervention(s)ICSI with or without office hysteroscopy.Main outcome measure(s)Undiagnosed uterine abnormalities, implantation and clinical pregnancy rates.Result(s)Unsuspected abnormal uterine findings were diagnosed in 35/105 (33.3%) patients with normal HSG and/or TVS among patients in group II by using office hysteroscopy. Implantation rate and clinical pregnancy rate were statistically significant between group I and group II, as clinical pregnancy rate between group I, group IIa (ICSI with normal office hysteroscopy) and group IIb (ICSI with abnormal office hysteroscopy) were 27.2%, 35.7%, 42.8%, respectively (P ? 0.05). Among group II 51 patients (48.5%) have repeated IVF or ICSI failure, 23 patients of them (45%) had abnormal hysteroscopy finding and 15 patients (65.2%) achieved pregnancy after correction of their uterine abnormalities. Hysteroscopy has high specificity (88%), high diagnostic accuracy (86.2%) but less sensitivity (80%) in predicting intrauterine abnormalities when compared to HSG and TVS (odd’s ratio 1.7, CI 1.33–2.44).Conclusion(s)The incidence of pathologic abnormalities based on hysteroscopic diagnosis was high especially with repeated IVF failure. Improvement in implantation and clinical pregnancy rates were observed after office hysteroscopy prior to ICS. So routine office hysteroscopy should be an essential step of the infertility workup before ART even in patients with normal HSG and /or TVS.     

Hysteroscopy and menopause: past and future

PURPOSE OF REVIEW: The main aim in investigating post-menopausal women is to exclude endometrial cancer. The purpose of this review is to define up-to-date clinical guidelines for the management of all post-menopausal women (asymptomatic as well as symptomatic). RECENT FINDINGS: Thanks to improvements in both the technology and the technique, hysteroscopy has become a simple and painless procedure that can easily be performed in an office or outpatient setting without any particular discomfort for the patient. The new, easier procedure, well tolerated by patients, has excellent diagnostic and surgical accuracy. Assuming that office hysteroscopy could offer a better visualization of the uterine cavity without increasing patient discomfort if compared to ultrasound, various authors have recently proposed the use of hysteroscopy as a first-line procedure in the approach to the menopausal patient. This could be defined as a change in strategy that has yielded very interesting results in terms of a better understanding of the appearance of the uterine cavity and the clinical value of small intra-cavitary pathologies (and their related treatment), particularly in asymptomatic women. SUMMARY: Hysteroscopy can be considered a routine outpatient method providing immediate results and causing minimal discomfort, especially when performed with the vaginoscopic approach. This technique has ushered in a new era of very-low-cost hysteroscopy, because only the hysteroscope is required in the outpatient procedure, with no need for additional instruments, medication, extra personnel or dedicated theatre. The time taken is comparable to that required for transvaginal sonography.     

The role of outpatient diagnostic hysteroscopy in identifying anatomic pathology and histopathology in the endometrial cavity

STUDY OBJECTIVE: To evaluate the role of outpatient diagnostic hysteroscopy. DESIGN: Retrospective review (Canadian Task Force classification II-2). SETTING: University teaching hospital-based outpatient clinic. PATIENTS: One thousand six hundred women, 67.3% premenopausal and 32.7% postmenopausal. INTERVENTION: Diagnostic hysteroscopy without premedication or anesthesia; endometrial sampling or hysteroscopy-guided biopsy was performed when appropriate. MEASUREMENTS AND MAIN RESULTS: Outpatient hysteroscopy was successfully performed in 1468 women (91.8%). Eleven women (0. 7%) developed vasovagal response during the procedure, 18 required hospital admission because of pain or hemorrhage, and 2 were suspected of having uterine perforation. All recovered spontaneously without intervention. Intrauterine anatomic pathology was diagnosed in 17.0%; the overall frequency of myomas and endometrial polyps was 12.3% and 7.1%, respectively. The sensitivity and positive predictive value of hysteroscopy without biopsy in diagnosing endometrial carcinoma were only 58.8% and 20.8%, respectively. Of 1112 women with hysteroscopic impression of normal or atrophic endometrium, 10 (0.9%) had endometrial hyperplasia on biopsy. CONCLUSION: Hysteroscopy without biopsy carries low sensitivity and positive predictive value in the diagnosis of endometrial carcinoma and hyperplasia. In our opinion the predictive value of a negative hysteroscopy is inadequate, and endometrial biopsy should be performed during hysteroscopy for accurate diagnosis of endometrial histopathology.     

Comparison of the accuracy of hysteroscopy and hysterosalpingography in evaluation of the uterine cavity in patients with recurrent pregnancy loss

The aim of this study was to compare the accuracy of hysteroscopy and hysterosalpingography (HSG) in evaluating the uterine cavity in patients with recurrent pregnancy loss (RPL). One hundred and twenty consecutive patients with a history of RPL were enrolled into this prospective-observational study in the reproductive endocrinology and infertility clinic of a tertiary referral center. Diagnostic office hysteroscopy without anesthesia or sedation, HSG, and diagnostic laparoscopy when indicated were performed in each case. Eighty-five of 120 (70.83%) hysteroscopic studies performed for RPL demonstrated an acquired (55 cases: 64.7%) or congenital (30 cases: 35.3%) intrauterine lesion. Furthermore, several other etiologic factors were also identified in RPL patients with intrauterine lesions. HSG accurately diagnosed an intrauterine defect in only 56 of 85 (65.88%) cases, based on hysteroscopic confirmation. Fifty percent of the cases with incomplete uterine septum were overlooked during HSG. The sensitivity, specificity, positive predictive value, and negative predictive value of HSG were 74.6%, 79.5%, 90.4%, and 54.7%, respectively. There was a single complication (0.83%) due to hysteroscopy. Hysteroscopy is more accurate than HSG in evaluating the uterine cavity in patients with RPL. We recommend it as a routine procedure instead of HSG.     

Hysteroscopy requirements and complications

With this study, possible complications of diagnostic and surgical hysteroscopy were identified in order to define minimum safety requirements for the technique in three different healthcare settings: the physician's office, the outpatient clinic and the operating room. A literature review was conducted to compare the results in terms of feasibility and simplicity, as well as complications associated with the use of various instruments and techniques. Thanks to advances in technologies and procedures, diagnostic hysteroscopy has an excellent safety profile and is widely accepted. With the aid of minioptics (lens or fiber <4 mm in diameter), success rates have increased and hysteroscopy-associated pain has been considerably reduced. Published studies report low complication rates with minioptic hysterectomy. Surgical interventions conventionally performed on an inpatient basis (polypectomy, myoma removal) can be carried out under an outpatient or day surgery regime without the need for cervical canal dilation or anesthesia. The complications rate following hysteroscopy depends on the diameter and type of the instrument, the duration of the intervention, the extent and type of the disorder and the patient's clinical condition. Based on the study findings, the following recommendations for procedures and services can be made: diagnostic hysteroscopy with or without anesthesia performed as a simple ambulatory or gynaecologist's office procedure; surgical hysteroscopy for polypectomy, removal of myomas G0 <1 cm, synechiae and metroplasty as an ambulatory surgical procedure; surgical hysteroscopy for polypectomy, removal of myomas G0 <1 cm, synechiae and metroplasty as a safe ambulatory surgical procedure (in at-risk patients); surgical hysterectomy for myomectomy, voluminous polyps, metroplasty as a surgical procedure in day surgery.     

Indications of diagnostic hysteroscopy, a brief review of the literature

Plenty of authors propose outpatient hysteroscopy as the gold standard diagnostic method for the evaluation of endometrial pathology. This statement has been strengthened in the recent years due to the wide use of smaller diameter hysteroscopic devices, which have made the dilation of the cervix and the use of anesthesia unnecessary. The main purpose of this paper is to summarize the indications of diagnostic hysteroscopy. In this review, we used the most recent publications in MEDLINE and Cochrane Library in order to specify the indications of diagnostic hysteroscopy and the experience that have been obtained till today in the management of certain pathological uterine conditions. The key words we used were diagnostic hysteroscopy, abnormal uterine bleeding, infertility, endometrial cancer. Hysteroscopy provides an accurate method of evaluation and direct visualization of the endometrial cavity and moreover directed biopsy and sampling of suspected lesions. Last years with the continuous development in the hysteroscopy devices, plenty of women benefit surgical hysteroscopy techniques for uterine abnormalities. Hysteroscopy is useful for the diagnosis in patients with abnormal uterine bleeding, with endometrial cancer and in infertile women. Hysteroscopy has the unique advantage of combining a thorough procedure with great diagnostic accuracy. The only disadvantage is that hysteroscopy requires specific teaching and training and has a long learning curve.     

Diagnostic hysteroscopy and saline infusion sonography in the diagnosis of intrauterine abnormalities: an assessment of patient preference

This study was conducted to assess whether women would prefer to undergo saline infusion sonography (SIS) or office hysteroscopy for the investigation of the uterine cavity. In a randomised controlled trial, 100 patients underwent SIS or office hysteroscopy for assessing patients' pain scores. After the investigation, 92 of them were asked to fill out an anonymous questionnaire addressing their preference regarding the method of evaluation and treatment of the uterine cavity. A control group, consisting of 50 women who never underwent SIS or office hysteroscopy, was also asked to complete an identical questionnaire. The questionnaire was completed by 113 women (83.7%). Twenty-four (21.2%) women would opt for SIS, whereas 52 (46.0%) would opt for office hysteroscopy, and 37 (32.7%) had no preference. If therapy would be necessary, 48.7% of the women would opt for an outpatient treatment, whereas 33.0% of the women would prefer treatment under general anaesthesia. Despite the fact that SIS is less painful, the majority of the women prefer office hysteroscopy. Additionally, therapy in an outpatient setting is preferred to a day case setting.     

Long-term results of hysteroscopic myomectomy in 235 patients

OBJECTIVE: To assess the efficacy of transcervical resection of submucous fibroids according to type and size. MATERIALS AND METHODS: Retrospective follow-up of 235 women with submucous fibroids at outpatient hysteroscopy who underwent a hysteroscopic transcervical resection. The main indications were the abnormal uterine bleeding and fertility problems. Thirty-seven percent of patients had an associated endometrial ablation and 32% had a polyp resection. Fifty-one percent of women were menopausal. In cases of incomplete resection a repeat procedure was offered. RESULTS: Intra-operative complications were rare (2.6%) and there was no major complication. Eighty-four percent of cases were followed-up. The median follow-up was 40 months (range 18-66 months). The procedure was classed as a success in 94.4% of patients. Among the cases that were classed as a failure, four patients had a repeated hysteroscopic procedure, three patients had a subsequent hysterectomy and four patients presented with abnormal uterine bleeding at follow-up. CONCLUSION: The hysteroscopic transcervical resection of submucous fibroids is a safe and highly effective long-term therapy for carefully selected women presenting with abnormal uterine bleeding and fertility problems. It produces satisfactory long-term results with few complications.     

Diagnostic fibrohysteroscopic evaluation of perimenopausal and postmenopausal uterine bleeding: A comparative study with Belgian and Japanese data

The most appropriate hysteroscope is the smallest that allows one to perform a biopsy. We use a 3.5- or 4.9-mm Olympus flexible hysteroscope with a failure rate below 3% for office or hospital ambulatory procedures without anesthesia or cervical dilatation. In postmenopausal women (with no hormone treatment) with uterine bleeding, we do not perform hysteroscopy if vaginal sonography detects endometrial thickness less than 4 mm. At this cut-off limit the calculated risk for not detecting an endometrial abnormality is 5.5%. In al other patients we prefer fibrohysteroscopy because its diagnostic accuracy is higher than that of vaginal ultrasound, vaginal ultrasound can easily miss a focal lesion of hyperplasia or adenocarcinoma incipiens, and abnormal endometrial findings detected by vaginal ultrasound or sonohysterography require directed biopsy during hysteroscopy. A comparative study evaluated the experience in our two series (286 patients), a Belgian report (251), and a Japanese report (444). Apart from myoma, 50% of findings were atrophic normal endometrium, and concordance was good for detecting adenocarcinoma (±3%). The results suggest using the fibrohysteroscope rather than the rigid scope because of its excellent accuracy.     

A comparison of outpatient hysteroscopy with saline infusion hysterosonography

Objectives To establish the accuracy of saline infusion hysterosonography in diagnosing uterine pathology when compared with outpatient hysteroscopy.
Design Prospective, parallel, blinded comparative study.
Setting Outpatient hysteroscopy clinic in a large university teaching hospital.
Population All women referred for outpatient hysteroscopy in a 15-month period.
Interventions Women underwent saline infusion hysterosonography followed by flexible hysteroscopy. The ultrasonographer was blinded to the hysteroscopy result and the gynaecologist was blinded to the saline infusion hysterosonography result.
Main outcome measures The relative success rates and pain scores for each procedure. The validity of saline infusion hysterosonography as a diagnostic test.
Results One hundred and seventeen women entered the study; 70 women were premenopausal and 47 postmenopausal. In 27 women, one or both procedures could not be performed. Saline infusion hysterosonography failed in 20 women, on one occasion hysteroscopy failed and both investigations failed in six women. Ninety cases remained for direct comparison, with 78 cases of agreement on the uterine findings in both investigations. Twelve cases disagreed; in one case, an adhesion was seen, two cases with polyps and five with fibroids seen on ultrasound but not seen on hysteroscopy. There were four cases where polyps were identified on hysteroscopy but not on saline infusion hysterosonography. The median pain scores were 1.6 for saline infusion hysterosonography and 3.2 for hysteroscopy.
Conclusions Both saline infusion hysterosonography and hysteroscopy are well tolerated by women. Saline infusion hysterosonography has a high failure rate but has a lower pain score than hysteroscopy.     

Diagnostic possibilities of the flexible hysteroscopy in irregular uterine bleeding

The aim of the present study was to evaluate the possibilities of diagnostic flexible hysteroscopy for women with irregular uterine bleeding. The study was based on 569 women aged between 26 and 72 years (mean age 46.78 years) with weak to moderate irregular uterine bleeding who had given agreement for invasive investigations. To all patients initially was performed diagnostic hysteroscopy with the help of a panoramic fibrohysteroscope Pentax LH-150 II (with 5 mm diameter), followed by classical endometrial curettage. The performed hysteroscopies found phase or other normal endometrium at 208 women (36.56%), hyperplasia and poliposis at 258 (45.34%), changes, suspected for atypia and neoplasia at 77 (13.53%) and other different findings at 26 women (4.57%). The following curettage showed the lack of adequate material from uterine cavity at 24 women (4.2%). From the rest patients, at 466 (81.9%) the morphological findings were due to the dysfunctional reasons, other 51 (8.9%) were with different precancer and cancer lesions and at 28 cases, clinically and morphologically was found that the bleeding was due to the presence of sub mucous nodules, intrauterine devices, residua and pathology of the chorion. The comparison of the hysteroscopy results with the clinical and histological findings from the curettage of 454 women, showed good diagnostic possibilities (sensitivity of 78.4% and specificity of 92.5%) of the flexible hysteroscopy for evaluation of women with irregular uterine bleeding. This examination is relatively simple and save endoscopic technique, which require simultaneously performance of a direct biopsy, in order to improve its diagnostic accuracy.