Hysteroscopy in the diagnosis of postmenopausal uterine bleeding

Postmenopausal bleeding is a special diagnostic problem in gynecology on account of inadequate specimen obtained during dilatation and curettage for pathologic examination. Instead, hysteroscopy proves to be an ideal procedure in defining the cause of bleeding through direct vision of the pathologic lesions in the uterine cavity. In this series, hysteroscopy was performed in 150 patients with postmenopausal bleeding. The causes of bleeding enumerated by the order of frequency of occurrence are atrophic endometrium, exogenous estrogen effect, unremoved IUD, endometrial carcinoma, submucous myoma and endometrial polyps.     

Patients' preferences in the evaluation of postmenopausal bleeding

Objective  To assess patients' preferences for diagnostic management of postmenopausal bleeding (PMB).
Design  A structured interview.
Setting  A teaching hospital with office hysteroscopy facilities.
Population  Thirty-nine women with PMB and with a completed work-up including an office hysteroscopy.
Methods  A structured interview was taken from 39 women who had had an office hysteroscopy in the diagnostic work-up for PMB. Women were informed about the probability of endometrial carcinoma versus benign disease and about advantages and disadvantages of different diagnostic strategies, i.e. expectant management after ultrasound or complete diagnostic work-up, including invasive procedures.
Main outcome measures  Women were informed about the probability of endometrial carcinoma versus benign disease and about advantages and disadvantages of different diagnostic strategies, i.e., expectant management after ultrasound or complete diagnostic work-up including invasive procedures. Women were asked to make a trade-off between different options.
Results  Most women wanted to be 100% certain that carcinoma could be ruled out. Only 5% of the women were willing to accept more than 5% risk of false reassurance. If the risk of recurrent bleeding due to benign disease exceeded 25%, the majority of women would prefer immediate diagnosis and treatment of benign lesions.
Conclusion  Women with PMB are prepared to undergo hysteroscopy to rule out any risk on cancer. This finding implicates that the measurement of endometrial thickness with transvaginal ultrasound as a first-line test in the assessment of PMB should be reconsidered.     

绝经后子宫内膜出血的临床病理分析

目的：研究绝经后子宫出血的病因,诊刮子宫内膜的病检及意义。方法：我院85例绝经后子宫出血的患者行诊刮术后子宫内膜组织送病检,标本以中性甲醛液固定,常规行石蜡包埋,HE染色后光镜下划分病理类型,作出结果统计。结采恶性肿瘤8例,腺癌为主;良性病变42例,单纯性增生及子宫内膜炎为主;非器质性病变35例,萎缩性子宫内膜占多数。结论：患者一旦出现绝经后子宫出血,需及时诊刮作病理检查,特别是老年妇女并绝经时间长者,在常规妇检后,须对可疑者行分段刮宫取子宫内膜作病理诊断。     

Rating of transvaginal sonography in the evaluation of postmenopausal bleeding

OBJECTIVE: The purpose of this study was to evaluate transvaginal ultrasonography (TVS) in differential diagnosis of vaginal bleedings in postmenopausal patients. MATERIAL AND METHODS: Between January 1990 and December 1996, 1198 postmenopausal patients with vaginal bleedings were sent to our clinic for a histological evaluation. Eight hundred and seventy-nine patients (73.4%) were preoperatively scanned by transvaginal probe, and endometrial thickness (< 5, 5-7, 8-10, > 10 mm) was measured. RESULTS: Atrophy was found in 46.3%, endometrial polyps in 19.8%, endometrial cancer in 17.5%, and hyperplasia in 6.7%. An endometrial thickness of lower than 5 mm (p < 0.0001) was shown in TVS patients with atrophy in 71%, with endometrial polyps in 10.9%, with endometrial cancer in 3.9% and hyperplasia in 6.8%. In 55.2% of these eases with endometrial cancer the preoperatively estimated thickness was 10 mm or more. The additionally morphologic examination in cases with an endometrium smaller than 5 mm was false positive in 75% (9/12). Thus an endometrial thickness of > 5 mm had a sensitivity of 92.5%, specificity of 71.0%, positive and negative predictive value of 75.6, respectively 90.9% for the detection of endometrial pathology. CONCLUSIONS: TVS allows the detection of an endometrial pathology in the vast majority of patients with postmenopausal bleedings. In cases with a single postmenopausal bleeding and an endometrium smaller than 5 mm we recommend expectative procedures with repeated ultrasound examination of the endometrium.     

绝经后出血的病理及相关因素分析

目的 :探讨绝经后出血的病因与诊断。方法 :对绝经后出血 12 65例进行临床与病理分析。结果 :非器质性病变致绝经后出血占 4 5 .4 % ,良性病变占 33.2 % ,恶性病变占 2 1.4 %。恶性病变中以子宫内膜癌与宫颈癌居多 ,分别占 5 9.0 %和 32 .8% ,恶性病变的比率随年龄的增加 ,绝经年限的延长逐渐上升 (P <0 .0 0 1)。结论 :子宫内膜非器质病变是绝经后出血的首要原因 ,子宫内膜癌和宫颈癌是最常见的恶性肿瘤。年龄越大 ,绝经年限越长 ,出血时间越长 ,恶性病变的可能性越大。经阴道B超检查应取代分段诊刮作为诊断绝经后出血的首选方法 ,结合宫腔镜检查有利于绝经后出血的诊断。     

Cytologic evaluation of the endometrium in women with postmenopausal bleeding

The records of 143 patients who had postmenopausal bleeding and underwent diagnostic curettage were reviewed. Of these patients 69% had benign endometrial tissue and in 8% there was insufficient tissue for histologic interpretation; 23% of the patients had endometrial carcinoma. In order to ascertain if endometrial cytology could predict which patients which patients may be harboring endometrial carcinoma, a prospective study was carried out on 69 patients complaining of postmenopausal bleeding. Prior to curettage, an endometrial cell sample was obtained with a disposable endometrial cell sampler. The preliminary data indicate good correlation between endometrial cytology and histology. There was one false-negative cytology report and one false positive report. Such a technique could eliminate an endometrial curettage in those patients in whom there is no clinical suspicion of endometrial carcinoma and the cytology is negative.     

TV sonographic assessment in postmenopausal women with bleeding

The aim of this study was to evaluate retrospectively the usefulness of transvaginal sonography for the detection of endometrial disease in postmenopausal women with bleeding. This study involved 275 postmenopausal women aged 47-81 years (median 62). None of them were on hormone replacement therapy and all had had amenorrhea for more than one year. Concerning the age of the study patients, we confirm that endometrial cancer occurs at any age, but more commonly in ages above 58 years. Transvaginal sonography was performed in all women. About 89.2% of malignant diseases were discovered in the study women whose endometrial thickness was above 4 mm, but we also found endometrial cancer in 10.2% of the cases in women whose endometrial thickness was below 4 mm. In postmenopausal symptomatic women premalignant or malignant causes of bleeding can not be excluded with just transvaginal ultrasound.     

绝经后阴道出血127例临床分析

目的　了解自然绝经后妇女阴道出血病因、病理。方法　选择 1 998年 1月～ 2 0 0 2年 1 2月在我院妇科住院和门诊就诊 ,以绝经后阴道出血为主诉的患者 1 2 7例。分为两组 ,Ⅰ组 73例 ,绝经 1年以上 ,5年以下 ;Ⅱ组 5 4例 ,绝经 5年以上。观察两组患者引起阴道出血原因。结果　Ⅰ组 73例患者引起阴道出血原因 :良性疾患 2 6例 ,占 35 6 % ;功能性病变 39例 ,占 5 3 4 % ;恶性肿瘤 8例 ,占 1 1 0 %。Ⅱ组 5 4例患者 ,引起阴道出血原因 :良性疾患 2 1例 ,占 38 9% ;功能性病变 1 4例 ,占 2 5 9% ;恶性肿瘤 1 9例 ,占 35 2 %。两组结果经 χ2 检验 ,P <0 0 1 ,差异有极显著性。结论　绝经后阴道出血 ,良性疾患和功能性病变为主要原因 ,绝经时间越长 ,出现的阴道出血 ,恶性肿瘤发生机率越大     

绝经后阴道出血380例分析

分析引起绝经后阴道出血的病因及诊断方法,方法对３８０例绝经后阴道出血患者进行临床及病理分析。结果因良性疾患引起的出血占５３．４２％,非器质性疾病占２６．８４％,恶性肿瘤占１９．７４％。子宫内膜病理检查显示破碎宫内膜和经期宫内膜４０例,增生反应４８例,萎缩宫内膜６例及分泌反应８例,因宫内膜及宫颈上非典型增生引起的出血２４例。恶性肿瘤以宫颈癌和宫体癌为主。患者出血时年龄大、绝经年限长及子宫增大、宫腔深     

Diagnosis and management of perimenopausal and postmenopausal bleeding

The menopausal years are characterized by a deficiency of progesterone and relative hyperestrogenism. This hormonal imbalance creates an environment favorable for the development of endometrial hyperplasia. The pathologic progression of hyperplasia to endometrial carcinoma can be arrested with progestogen therapy. A simple diagnostic approach for peri- and postmenopausal bleeding disorders is presented, along with a rational treatment regimen. Some of the risks and benefits of hormonal replacement therapy are discussed.