The role of hysteroscopy in diagnosis and treatment of postmenopausal bleeding.
OBJECTIVE
Abnormal uterine bleeding is the most common problem which brings woman to the gynecologist during the postmenopausal period. The aim of this study was to define the significance of hysteroscopy as a diagnostic procedure for the evaluation of patients with postmenopausal bleeding, as well as to define it as a surgical procedure by which the cause of bleeding can be treated in most cases in the same sitting.


METHODS
The study involved 148 female patients referred to the Clinic for Gynecology and Obstetrics in Nis for postmenopausal bleeding in the period of 12 months. Hysteroscopy with endometrial biopsy were performed in all the patients. Biopsy materials were directed to histological examination, and the hysteroscopic and histological findings were compared afterwards. Polyps and submucous miomas were hysteroscopically removed in the same sitting and also directed to histological examination.


RESULTS
The success rate of the method was 95.1%, while complications occurred in 1.37% of the cases. The hysteroscopic findings were normal in almost 30% of the cases, and the most common pathological finding was endometrial polyp. The sensitivity of hysteroscopy in the detection of intrauterine pathology was 100%, the specificity 81%, the positive predictive value 92% and the negative predictive value 100%. In 69.7% of the patients the cause of bleeding was hysteroscopically removed. Hysteroscopy was performed in 58.1% of the patients in the same sitting, and in 11.6% of the patients after obtaining histological findings.


CONCLUSIONS
Hysteroscopy is a safe, highly sensitive diagnostic procedure, thus being an ideal method for evaluation of patients with postmenopausal bleeding. The application of hysteroscopy with endometrial biopsy leads to accurate diagnosis. An adequate diagnosis is crucial for the selection of relevant treatment of postmenopausal bleeding and avoidance of unnecessary major surgical procedures. Except for being a diagnostic method hysteroscopy, is also an outpatient minimally invasive surgical procedure for treating the cause of bleeding in the majority of cases in the same sitting.
Clinic for Gynecology and Obstetrics, Clinical Center of Nis, Nis, Serbia. sonjapoptrajkovic@gmail.com
Sonja
S
Pop-Trajković-Dinić
Aleksandar
A
Ljubić
Vesna
V
Kopitović
Vladimir
V
Antić
Snezana
S
Stamenović
Aleksandra Trninić
AT
Pjević
D000368:Aged; D001706:Biopsy; D004717:Endometrium / Q000473:pathology*; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D007889:Leiomyoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D008796:Metrorrhagia / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D008875:Middle Aged; D011127:Polyps / Q000175:diagnosis / Q000601:surgery; D017698:Postmenopause; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery