Paul P Smith1, Siobhan O'Connor2, Janesh Gupta2, T Justin Clark2. 1. Birmingham Women's Hospital, Birmingham, United Kingdom. Electronic address: paul.smith@doctors.net.uk. 2. Birmingham Women's Hospital, Birmingham, United Kingdom.
Abstract
STUDY OBJECTIVE: To estimate the prevalence of genital tract diseases in women with initial and recurrent postmenopausal bleeding (PMB) to help inform diagnostic pathways. DESIGN: Prospective cohort study (Canadian Task Force classification: II-2). SETTING: Large urban teaching hospital. PATIENTS: Of 1938 consecutive women with postmenopausal bleeding, 106 (5%) were investigated for a recurrent episode after having normal findings of previous investigations. INTERVENTIONS: All women underwent pelvic examination and ultrasound scanning. An endometrial biopsy was performed when endometrial thickness was >4 mm in women with a first episode of PMB, with recourse to outpatient hysteroscopy after correlation between clinical and pathologic findings. All women with a recurrent PMB episode underwent endometrial biopsy and outpatient hysteroscopy. MEASUREMENTS AND MAIN RESULTS: The risk of having endometrial cancer or hyperplasia with atypia was significantly less in women with recurrent PMB (9%) as compared with those with a first episode of PMB (8%) (p = .002), but were significantly more likely to have benign endometrial polyps (28%) compared with women with a first episode of PMB (19%) (relative risk, 1.47; 95% confidence interval, 1.07-2.02; p = .02). CONCLUSION: Recurrent PMB results in less likelihood of premalignant and malignant endometrial disease; however, in 1 of 4 women PMB is caused by endometrial polyps. First-line investigation in women with recurrent PMB should be tests that have high accuracy for enabling diagnosis of focal diseases, such as outpatient hysteroscopy or saline infusion sonography.
STUDY OBJECTIVE: To estimate the prevalence of genital tract diseases in women with initial and recurrent postmenopausal bleeding (PMB) to help inform diagnostic pathways. DESIGN: Prospective cohort study (Canadian Task Force classification: II-2). SETTING: Large urban teaching hospital. PATIENTS: Of 1938 consecutive women with postmenopausal bleeding, 106 (5%) were investigated for a recurrent episode after having normal findings of previous investigations. INTERVENTIONS: All women underwent pelvic examination and ultrasound scanning. An endometrial biopsy was performed when endometrial thickness was >4 mm in women with a first episode of PMB, with recourse to outpatient hysteroscopy after correlation between clinical and pathologic findings. All women with a recurrent PMB episode underwent endometrial biopsy and outpatient hysteroscopy. MEASUREMENTS AND MAIN RESULTS: The risk of having endometrial cancer or hyperplasia with atypia was significantly less in women with recurrent PMB (9%) as compared with those with a first episode of PMB (8%) (p = .002), but were significantly more likely to have benign endometrial polyps (28%) compared with women with a first episode of PMB (19%) (relative risk, 1.47; 95% confidence interval, 1.07-2.02; p = .02). CONCLUSION: Recurrent PMB results in less likelihood of premalignant and malignant endometrial disease; however, in 1 of 4 womenPMB is caused by endometrial polyps. First-line investigation in women with recurrent PMB should be tests that have high accuracy for enabling diagnosis of focal diseases, such as outpatient hysteroscopy or saline infusion sonography.
Authors: Janelle B Pakish; Karen H Lu; Charlotte C Sun; Jennifer K Burzawa; Anthony Greisinger; Frances A Smith; Bryan Fellman; Diana L Urbauer; Pamela T Soliman Journal: J Womens Health (Larchmt) Date: 2016-06-02 Impact factor: 2.681
Authors: Min Kyoung Kim; Yeon Soo Jung; Seung Joo Chon; Bo Hyon Yun; Sihyun Cho; Young Sik Choi; Byung Seok Lee; Seok Kyo Seo Journal: J Korean Med Sci Date: 2017-05 Impact factor: 2.153
Authors: Ignacio Manuel Sánchez Barrancos; Francisco José Guerrero García; María Del Carmen Rico López; Vicente Fernández Rodríguez; Tomás Vegas Jiménez; Rafael Alonso Roca; Daniel Domínguez Tristancho Journal: Aten Primaria Date: 2018-05-30 Impact factor: 1.137