Diagnostic and operative hysteroscopy in the management of persistent postmenopausal bleeding.

OBJECTIVE

To determine the cause and possible treatment of postmenopausal bleeding of 6 months' duration or longer.

METHODS

One hundred ten women between the ages of 40-90 years with persistent postmenopausal bleeding were evaluated by diagnostic hysteroscopy and managed by operative hysteroscopy. All had endometrial sampling and/or office hysteroscopy before operative hysteroscopy.

RESULTS

A benign organic cause was noted in 95 cases (polyps in 42 and submucous fibroids in 53). Thirteen women had no significant disease and two had an early adenocarcinoma. Resection of the polyps or myomas without ablation was performed in 45 women, and all but one were satisfied with the results of treatment. Resection and ablation with performed in the remaining 50 patients with organic causes, and all but one were satisfied with the results. Twelve of 13 women without organic causes were satisfied with their treatment. The two adenocarcinomas were early lesions, grade 1 without invasion, and were managed by simple hysterectomy.

CONCLUSION

Diagnostic and operative hysteroscopy was effective in controlling postmenopausal bleeding of at least 6 months' duration. Almost 90% of the patients had either polyps or submucous fibroids as the primary cause of the bleeding. Resection alone and resection with ablation were equally effective in controlling the bleeding.