title: Management of postmenopausal bleeding in Sweden: a need for increased use of hydrosonography and hysteroscopy.
abstract: BACKGROUND
  The objective was to determine how postmenopausal bleeding (PMB) is managed in Sweden today, and to relate the findings to a new evidence-based algorithm for the management of PMB.
  
  
  METHODS
  A questionnaire regarding the role of ultrasound and the use of different endometrial biopsy methods in the management of PMB was sent to all 61 gynecologic departments in Sweden.
  
  
  RESULTS
  Fifty-nine of the 61 departments (97%) satisfactorily answered the questionnaire. Ultrasound was either always (n = 54, 92%) or most commonly (n = 5, 8%) used in the diagnostic work-up of PMB. In women with endometrial thickness < or =4 mm, 18 of the departments (31%) routinely sampled the endometrium; 12 (15%) followed the women with ultrasound; three (5%) did both sampling and follow-up with ultrasound; and the remaining 29 (49%) used expectant management (i.e. no biopsy or routine follow-up). In women with endometrium > or =5 mm, hydrosonography was performed routinely in two departments (3%), occasionally in 37 departments (63%), and never in 20 departments (34%). In women with endometrium > or =5 mm, endometrial biopsy was obtained routinely by Endorette/Pipelle in 39 departments (66%), while in 26 departments (44%) operative hysteroscopy was never performed.
  
  
  CONCLUSIONS
  More than one-third of the gynecologic departments in Sweden never perform hydrosonography to rule out focal lesions or operative hysteroscopy for the removal of such lesions. Hydrosonography and hysteroscopy have a central role in the new guidelines for the management of PMB. Therefore, a need exists to broaden the use of hydrosonography and hysteroscopy.
authors.affiliation: Department of Obstetrics and Gynecology, Malmö University Hospital, SE-205 02 Malmö, Sweden. elisabeth.epstein@obst.mas.lu.se
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Epstein
mesh_terms: D001706:Biopsy; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D008875:Middle Aged; D017698:Postmenopause; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011859:Radiography; D011795:Surveys and Questionnaires; D013548:Sweden; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*