Hysteroscopic evaluation of patients with abnormal uterine bleeding.

Abnormal uterine bleeding is the most common indication for dilation and curettage. Because of the pitfalls involved with this blind procedure, hysteroscopy was added for the evaluation of the patient in this study. In 419 premenopausal and 134 postmenopausal patients who had abnormal uterine bleeding, hysteroscopy was performed prior to dilation and curettage, and directed biopsies were obtained under hysteroscopic view when abnormal lesions were discovered. In 352 patients, an abnormality was hysteroscopically detected, such as endometrial polyps, submucous leiomyomas, intrauterine adhesions and focal lesions compatible with adenomatous hyperplasia or endometrial carcinoma, many of which were not detected at the subsequent dilation and curettage. Hysteroscopy provides a precise and accurate adjunct to traditional methods of diagnosing intrauterine abnormalities, particularly focal lesions which may be missed at curettage.