One-stop clinic for postmenopausal bleeding.
OBJECTIVE
To evaluate the role of one-stop clinic for early diagnosis and management of women with postmenopausal bleeding by means of transvaginal ultrasonography, outpatient hysteroscopy and endometrial biopsy.


METHODS
A prospective analysis was performed on 522 women with postmenopausal bleeding who were referred directly to the gynecology outpatient clinic for evaluation of postmenopausal bleeding. Endometrial thickness of 6 mm, as measured by a transvaginal scan, was considered the cutoff limit for further investigation by hysteroscopy and endometrial biopsy.


RESULTS
One hundred ninety-one women were using hormone replacement therapy. Thirty-two were taking tamoxifen. Outpatient hysteroscpoy was performed in 157 (71.3%) cases. Thirty-seven (16.8%) cases had general anesthesia for hysteroscopy. Twenty-four (11%) cases had only an endometrial sample obtained. Twenty-one cases of endometrial carcinoma, 20 of endometrial hyperplasia, 4 of cervical carcinoma and 5 of other genital tract malignancies along with several benign pathologies, including submucosal myomas, were detected. Seven (2.3%) cases of endometrial thickness below the cutoff limit had recurrent bleeding due to benign conditions.


CONCLUSIONS
A one-stop clinic is effective for early diagnosis of genital tract malignancy in a majority of patients with postmenopausal bleeding and significantly help in reducing the hospital waiting list.
Panda
Jitendra K
JK
Department of Obstetrics and Gynaecology, Poole General Hospital, Dorset, U.K.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D004717:Endometrium / Q000473:pathology; D005260:Female; D005833:Genital Neoplasms, Female / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D015907:Hysteroscopy; D008875:Middle Aged; D017698:Postmenopause; D011446:Prospective Studies; D013997:Time Factors; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D014621:Vagina / Q000000981:diagnostic imaging