The value of hysteroscopy in postmenopausal and perimenopausal bleeding

Prevalence of bladder tumors in women referred with postmenopausal bleeding

OBJECTIVES

The aim of this study is to identify the prevalence of urinary bladder (UB) tumors in women presenting with postmenopausal bleeding (PMB).

STUDY DESIGN

A prospective cohort study. New patients presenting for the PMB clinic in the period June 2002-June 2003 underwent transvaginal ultrasound scan (TVUS). All cases where bladder pathology was identified during TVUS were referred for urological opinion. Cystoscopy was undertaken in all cases and subsequent histological examination was carried out.

MAIN OUTCOME MEASURES

Benign and malignant urinary bladder tumors.

RESULTS

Two hundred eighty new referrals were reviewed in the PMB clinic. Three cases of UB tumors were identified on TVUS, none of them had an endometrial pathology and all cases had subsequent cystoscopy that confirmed the TVUS findings and resection of the bladder tumors was undertaken. Histological examination revealed one benign and two malignant urinary bladder tumors that were all completely excised.

CONCLUSION

The prevalence of bladder tumors in women presenting with PMB in our population was found to be 1.07%, and the prevalence of bladder cancer was 0.7%.

A randomised controlled trial comparing transvaginal ultrasound, outpatient hysteroscopy and endometrial biopsy with inpatient hysteroscopy and curettage

OBJECTIVE

To compare the use of outpatient and inpatient procedures in the investigation of abnormal uterine bleeding.

DESIGN

A randomised controlled trial.

SETTING

Two university teaching hospitals.

PARTICIPANTS

Four hundred women with abnormal uterine bleeding (postmenopausal bleeding, menorrhagia, intermenstrual bleeding, postcoital bleeding, or irregular periods) above the age of 35 years, between June 1993 and January 1995.

MAIN OUTCOME MEASURES

1. Incidence of detection of abnormal pathology by vaginal ultrasound, outpatient hysteroscopy and endometrial biopsy compared with inpatient hysteroscopy and curettage; 2. Number of 'lesions' (e.g. fibroids, polyps, endometrial hyperplasia or malignancy) found by hysteroscopy that would have been missed by the combination of endometrial sampling and ultrasound; 3. Comparison of the quality of tissue obtained for histology by outpatient endometrial sampling and inpatient curettage; and 4. An evaluation of patient acceptability of outpatient and inpatient procedures.

RESULTS

1. A combination of transvaginal sonography, Pipelle endometrial biopsy and outpatient hysteroscopy has similar efficacy to inpatient hysteroscopy and curettage for the investigation of abnormal uterine bleeding; 2. Hysteroscopy will detect some fibroids and polyps missed by a combination of transvaginal ultrasound and Pipelle endometrial sampling; 3. The quality of histological samples obtained by outpatient Pipelle were comparable to those obtained by formal inpatient curettage; and 4. Outpatient procedures were well tolerated, with good patient acceptability.

CONCLUSION

Transvaginal sonography and endometrial biopsy can safely be used as the initial investigations in the management of abnormal uterine bleeding. Hysteroscopy can be used as a second line investigation. Outpatient hysteroscopy with local anaesthesia is well tolerated although general anesthesia may occasionally be necessary.