Rebleeding and endometrial growth in women with postmenopausal bleeding and endometrial thickness < 5 mm managed by dilatation and curettage or ultrasound follow-up: a randomized controlled study.
OBJECTIVE
To compare the frequency of rebleeding and endometrial growth during a 12-month follow-up period between women with postmenopausal bleeding and an endometrial thickness < 5 mm managed by dilatation and curettage, and those managed by ultrasound follow-up.


METHODS
Consecutive women with postmenopausal bleeding and an endometrial thickness < 5 mm were randomized to ultrasound follow-up after 3, 6, and 12 months (n = 48) or to primary dilatation and curettage with ultrasound follow-up at 12 months (n = 49). At all follow-up examinations, the endometrial thickness was measured and the women were asked about rebleeding. The endometrium was sampled at the 12-month examination, if sampling had not been performed previously because of rebleeding or endometrial growth.


RESULTS
Rebleeding was reported by 33% (16/48) of the women in the ultrasound group and by 21% (10/48) of those in the dilatation and curettage group (P = 0.17). Endometrial growth to >or= 5 mm was found in 21% (10/48) of the women in the ultrasound group and in 10% (5/48) of those in the dilatation and curettage group (P = 0.16). No endometrial pathology was found in women with isolated rebleeding. Endometrial pathology during follow-up was found more often in women with endometrial growth than in those without (33% vs. 4%; P = 0.008).


CONCLUSIONS
Rebleeding and endometrial growth are common during a follow-up period of 12 months in women with postmenopausal bleeding and an endometrial thickness < 5 mm, irrespective of whether or not dilatation and curettage is primarily carried out. If these women are managed by ultrasound follow-up, endometrial sampling should be performed if the endometrium grows, but not necessarily in the case of rebleeding without endometrial growth.
Epstein
E
E
Department of Obstetrics and Gynecology, University Hospital, Malmö, Sweden. elisabeth.epstein@obst.mas.lu.se
Valentin
L
L
D000368:Aged; D001706:Biopsy; D004107:Dilatation and Curettage; D004714:Endometrial Hyperplasia / Q000175:diagnosis; D016889:Endometrial Neoplasms / Q000175:diagnosis; D004717:Endometrium / Q000000981:diagnostic imaging* / Q000473:pathology; D015914:Estrogen Replacement Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D011446:Prospective Studies; D012008:Recurrence; D014463:Ultrasonography; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis; D014592:Uterine Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D014626:Vaginal Smears