THE ROLE OF HYSTEROSCOPY USED AS A DIAGNOSTIC TOOL IN THE EVALUATION OF POSTMENOPAUSAL BLEEDING AND ITS MANAGEMENT STRATEGIES.

Dr Vidya V Bhat, Dr Yoga Lakshmi S.K

Abstract


Objectives:
1) To study the role of hysteroscopy as a diagnostic tool in the evaluation of postmenopausal bleeding.
2) To plan management strategies according to the findings in the hysteroscopy procedure.
Materials and Methods
Type of the study: It is a r etrospective analysis from June 2012 to June 2017.
Setting: In department of obstetrics and gynecology in Radhakrishna Multispeciality Hospital and IVF centre.
Ÿ The present study includes 1600 cases of postmenopausal bleeding from June 2012 to June 2017.
Ÿ Exclusion criteria- women with history of HRT.
Ÿ Local causes such as bleeding from vagina or cervix
Ÿ known case of bleeding disorder.
Ÿ patient on anticoagulant therapy.
Ÿ The study includes 1600 cases with history of postmenopausal bleeding for which hysteroscopy was performed and
also the patient who required operative treatment was done in same setting.
Ÿ The HPE findings are divided into 4 categories- Normal, Atrophic endometrium, Endometrial hyperplasia & Endometrial
carcinoma.
Results:
Ÿ 1280 cases were found to have normal or atrophic endometrium for which they were followed up accordingly.
Ÿ 306 cases were found to have simple hyperplasia medical treatment given for them as first line of management and
followed up.
Ÿ 14 cases with endometrial cancer for which stage wise management was done.
Conclusion
Ÿ Hysteroscopy in postmenopausal bleeding patients is a very good diagnostic tool for diagnosing Endometrial carcinoma and
to prevent unnecessary surgery in women with normal HPE and simple hyperplasia.
Ÿ Hysteroscopy along with directed endometrial biopsy proved to be useful diagnostic aid in cases of postmenopausal bleeding.


Keywords


Hysteroscopy, Postmenopausal Bleeding.

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References


Ben-Yehuda OM, Kim YB, Leuchter RS. Does hysteroscopy improve upon the sensitivity of dilatation and curettage in the diagnosis of endometrial hyperplasia or carcinoma? Gynecol Oncol. 1998;68(1):4-7.

Word B, Gravlee LC, Wideman GL. The fallacy of simple uterine curettage. Obstet Gynecol. 1958;12(6):642-8.

Stock RJ, Kanbour A. Prehysterectomy curettage. Obstet Gynecol. 1975;45(5):537-41.

Lidor A, Ismajovich B, Confino E, David MP. Histopathological findings in 226 women with postmenopausal uterine bleeding. Acta Obstet Gynecol Scand. 1986;65:41-3.

Ubeja A et al. Clinicopathological evaluation of postmenopausal bleeding in rural hospital set up.. Int J Reprod Contracept Obstet Gynecol. 2017 Aug;6(8):3556-3559

Karlsson B, Granberg S, Wikland M, Ylostalo P, Torvid K, Marsal K, et al. TVS of the endometrium in women with PMB- a Nordic Multicentre study. Am J Obstet Gynecol 1995;172:1488-94.

Ferrazzi E et al., Sonographic endometrial thickness: a useful test to predict atrophy in patients with PMB. An Italian multicentre study. Ultrasound obstet Gynecol 1996;7:315-21.

Gull B, Carlsson et l., TVS of the endometrium in women with PMB : is it always necessary to perform an endometrial biopsy? Am J obstet Gynecol 2000; 182:509-15.

Epstein E et al., Rebleeding and endometrial growth in women with PMB and ET<5mm managed by dilatation and curettage or US follow up: a RCT study. Ultrasound Obstet Gynecol 2001;18:499-504.

Gull B, Karlsson B, Milsom I, Granberg S. Can ultrasound replace dilatation and curettage? A longitudinal evaluation of PMB and TVS measurement of the endometrium as predictors of endometrial cancer. Am J Obstet Gynecol 2003; 188:401-8.

Sunitha Tandulwadkar, Prashant Deshmukh, Pooja Lodha, and Bhavana Agarwal.Hysteroscopy in Postmenopausal Bleeding. J Gynecol Endosc Surg. 2009 Jul-Dec; 1(2): 89–93.

Karlsson B, Granberg S, Wikland M, Ylostalo P, Torvid K, Marsal K, et al. TVS of the endometrium in women with PMB- a Nordic Multicentre study. Am J Obstet Gynecol 1995;172:1488-94.

Ferrazzi E et al., Sonographic endometrial thickness: a useful test to predict atrophy in patients with PMB. An Italian multicentre study. Ultrasound obstet Gynecol 1996;7:315-21.

Gull B, Carlsson et l., TVS of the endometrium in women with PMB : is it always necessary to perform an endometrial biopsy? Am J obstet Gynecol 2000; 182:509-15.

Epstein E et al., Rebleeding and endometrial growth in women with PMB and ET<5mm managed by dilatation and curettage or US follow up: a RCT study. Ultrasound Obstet Gynecol 2001;18:499-504.

Gull B, Karlsson B, Milsom I, Granberg S. Can ultrasound replace dilatation and curettage? A longitudinal evaluation of PMB and TVS measurement of the endometrium as predictors of endometrial cancer. Am J Obstet Gynecol 2003; 188:401-8.

Sunitha Tandulwadkar, Prashant Deshmukh, Pooja Lodha, and Bhavana Agarwal.Hysteroscopy in Postmenopausal Bleeding. J Gynecol Endosc Surg. 2009 Jul-Dec; 1(2): 89–93.


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