Hysteroscopy—A Mode of Screening Women with Postmenopausal Bleeding: Our Experience

Study Objective: 1. To study the etiology of postmenopausal bleeding. 2. To study the significance of hysteroscopy in evaluation of the etiopathogenic factors. 3. Correlating the diagnosis after transvaginal sonography (TVS), hysteroscopy and histopathology. 4. Feasibility of conservative management with hysteroscopy in postmenopausal bleeding. Design: Prospective study from January 2009 to June 2010. Setting: Department of Obstetrics and Gynecology of Ruby Hall Clinic, Pune, Maharashtra, India. Sample size: Sixty postmenopausal women with complaint of bleeding per vaginum. Interventions: Clinical and sonographic evaluation followed by diagnostic and/or therapeutic hysteroscopy and guided biopsy. Hysteroscopic images were analyzed and compared with histopathological results. Measurements and main results: On hysteroscopy, endometrium is classified as suggestive of normal, atrophic, endometrial hyperplasia or endometrial carcinoma. Histopathological diagnosis was taken as a gold standard to determine the efficacy of hysteroscopy in diagnosing endometrial pathologies. The sensitivity and specificity of hysteroscopy in diagnosing endometrial pathologies was assessed. Conclusions: In women with postmenopausal bleeding, hysteroscopy is a valuable tool that allows precise diagnosis of various endouterine pathologies. In our study, the sensitivity of hysteroscopy was 97% and the specificity was 98.66%. Hence, we can conclude that it is highly accurate for evaluating endometrial pathologies. For obvious benign lesions, it also provides treatment in the same sitting, therefore avoiding an extensive, morbid, and expensive procedure like hysterectomy.