Out-patient hysteroscopy in asymptomatic postmenopausal women.
OBJECTIVE
To determine the prevalence of uterine and endometrial abnormalities in normal postmenopausal women and assess the accuracy of subjective hysteroscopic appearances and endometrial histology following 12 weeks of hormonal treatment.


METHODS
A multicentered randomized double-blind placebo-controlled trial in which the volunteers received conjugated equine estrogen 0.625 mg, selective estrogen receptor modulator (in one of two doses) or placebo.


METHODS
Out-patient endoscopy unit in a large teaching hospital.


METHODS
Out-patient hysteroscopy and endometrial biopsy.


RESULTS
Forty-eight women had a hysteroscopy and endometrial biopsy: eight (16.6%; 95% confidence interval, CI 6-27%) women had intrauterine polyps and 38 (79.2%) women had normal hysteroscopies. Thirty-five women had a repeat endometrial assessment with hysteroscopy and, for the detection of proliferative endometrium (prevalence 22.8%), a sensitivity of 87.5%, a specificity of 74%, a negative predictive value of 95% and a positive predictive value of 50% were observed. There was a good proportion of agreement, 0.77 (95% CI 0.63-0.91), but a kappa score of 0.486 revealed only a moderate level of agreement. The likelihood ratios for proliferative endometrium were: LHR+ = 3.38 (fair), and LHR- = 0.17 (moderate).


CONCLUSIONS
Hysteroscopic assessment of the uterine cavity is efficient in the detection of pathological intrauterine lesions, but is only moderately successful in determining physiological changes in the endometrium. This study defines a standard of observational statistics for out-patient hysteroscopy in relation to normal endometrial histology in postmenopausal women who may have been ingesting exogenous estrogens.
Fay
T N
TN
Department of Obstetrics and Gynaecology, City Hospital Nottingham, Hucknall Road, Nottingham NG5 IPB, UK.
Khanem
N
N
Hosking
D
D
D000553:Ambulatory Care; D001284:Atrophy; D001706:Biopsy; D004311:Double-Blind Method; D016889:Endometrial Neoplasms / Q000473:pathology; D004717:Endometrium / Q000473:pathology*; D015914:Estrogen Replacement Therapy; D004966:Estrogens, Conjugated (USP) / Q000008:administration & dosage; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D008875:Middle Aged; D010919:Placebos; D011127:Polyps / Q000473:pathology; D017698:Postmenopause; D020845:Selective Estrogen Receptor Modulators / Q000008:administration & dosage; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000473:pathology
D004966:Estrogens, Conjugated (USP); D010919:Placebos; D020845:Selective Estrogen Receptor Modulators