Van Doorn H C, Timmermans A, Opmeer B C, Kruitwagen R F M P, Dijkhuizen F P H L J, Kooi G S, Van De Weijer P H M, Mol B W J, Dupomeb For
Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands.
Acta Obstet Gynecol Scand. 2008;87(1):89-93. doi: 10.1080/00016340701763130.
To determine the incidence and significance of recurrent postmenopausal bleeding among women diagnosed with an endometrial thickness < or =4 mm after a first episode of postmenopausal bleeding.
Consecutive patients not using hormone replacement therapy (HRT) presenting with a first episode of postmenopausal bleeding and an endometrial thickness < or =4 mm at transvaginal ultrasonography (TVU) were managed expectantly. In case of recurrent bleeding, the patient was evaluated according to the hospital's local policy with TVU, office endometrial sampling, hysteroscopy or dilatation and curettage (D&C) or a combination of these tests. We evaluated the incidence of recurrent bleeding, potential risk factors for recurrent bleeding, and the diagnosis made after recurrent bleeding.
A total of 607 patients were registered with a first episode of postmenopausal bleeding, of whom 249 had an endometrial thickness < or =4 mm. Follow-up took place with a median of 174 weeks (range: 4-250 weeks). During follow-up, 25 of the 249 patients (10%; 95% CI: 6.6-14%) had recurrent bleeding. Median time until recurrence of bleeding was 49 weeks (range: 9-186 weeks). Two patients with recurrent bleeding turned out to have an endometrial carcinoma (8%; 95% CI: 2.2-25%), and 1 patient had a malignant melanoma. Time since menopause, age, body mass index, hypertension, diabetes and anticoagulants were not predictive for recurrent bleeding.
The recurrence rate after a first episode of postmenopausal bleeding managed expectantly is low and cannot be predicted by patient characteristics. Patients with recurrent bleeding should be re-evaluated, as they bear a considerable risk of carcinoma.
确定绝经后首次出血且经阴道超声检查子宫内膜厚度≤4mm的女性中绝经后反复出血的发生率及意义。
对连续出现绝经后首次出血且经阴道超声检查子宫内膜厚度≤4mm、未使用激素替代疗法（HRT）的患者进行观察等待。若出现反复出血，则根据医院当地政策，通过经阴道超声检查、门诊子宫内膜取样、宫腔镜检查或刮宫术（D&C）或这些检查的组合对患者进行评估。我们评估了反复出血的发生率、反复出血的潜在危险因素以及反复出血后的诊断结果。
共有607例患者记录有绝经后首次出血，其中249例子宫内膜厚度≤4mm。随访时间中位数为174周（范围：4 - 250周）。在随访期间，249例患者中有25例（10%；95%置信区间：6.6 - 14%）出现反复出血。出血复发的中位时间为49周（范围：9 - 186周）。两名反复出血的患者被诊断为子宫内膜癌（8%；95%置信区间：2.2 - 25%），1例患有恶性黑色素瘤。绝经时间、年龄、体重指数、高血压、糖尿病和抗凝剂并不能预测反复出血。
对绝经后首次出血进行观察等待后的复发率较低，且无法通过患者特征进行预测。反复出血的患者应重新评估，因为他们患癌风险较高。
