Study of the role of hysteroscopy with dilation and curettage in post- menopausal bleeding: a cross sectional study
Keywords:Dilation and curettage, Hysteroscopy, Post-menopausal bleeding
Background: Abnormal uterine bleeding is defined as any type of bleeding in which the duration, frequency or amount is excessive for an individual patient. Hysteroscopy has ushered a new era in the evaluation of abnormal uterine bleeding. With this background, we conducted a study to find the role of hysteroscopy with dilation and curettage in post-menopausal bleeding.
Methods: It was an observational study conducted in the department of obstetrics and gynecology of a tertiary care hospital in Maharashtra. Post-menopausal patients with abnormal uterine bleeding, admitted in the period of March 2018 to September 2019 were included in the study. A pretested and predesigned questionnaire was used to collect the data. Hysteroscopy with dilation and curettage was done and samples were sent for histopathology.
Results: Bleeding was present in all the 30 cases. About 33.33% had pain abdomen, 56.67% had hot flushes, 10.00% had mass and 10% had other symptoms in the present study. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of hysteroscopy in diagnosing malignancy was 75%, 96.15%, 75%, 96.15% and 93.33% respectively.
Conclusions: To conclude the most common cause of abnormal uterine bleeding in post-menopausal women in our study was polyp. The sensitivity and specificity of the hysteroscopy in diagnosing the malignant lesions is 75% and 96.15% respectively which corroborated with other study findings. Hysteroscopy with dilation and curettage is better alternative to hysterectomy and biopsy in most of the cases.
Whitaker L, Critchley HOD. Abnormal uterine bleeding. Best Pract Res Clin Obstet Gynaecol. 2016;34:54-65.
Goldstein SR. Abnormal uterine bleeding: the role of ultrasound. Radiol Clin North Am. 2006;44(6):901-10.
Su H, Huang L, Huang KG, Yen CF, Han CM, Lee CL. Accuracy of hysteroscopic biopsy, compared to dilation and curettage, as a predictor of final pathology in patients with endometrial cancer. Taiwan J Obstet Gynecol. 2015;54(6):757-60.
Sinha P, Yadav N, Gupta U. Use of hysteroscopy in abnormal uterine bleeding: an edge over histopathological examination. J Obstet Gynaecol India. 2018;68(1):45-50.
Pandey VK, Aggarwal P, Kakkar R. Modified BG Prasad socio-economic classification, Update-2019. Indian J Community Heal. 2019;31(1):150-2.
World Health Organization guidelines for classification of anaemia, 2014. Available at: https://www.who.int/vmnis/indicators/haemoglobin.pdf. Accessed on 10th January 2020.
Elfayomy AK, Habib FA, Alkabalawy M. Role of hysteroscopy in the detection of endometrial pathologies in women presenting with postmenopausal bleeding and thickened endometrium. Arch Gynecol Obs. 2012;285:839-43.
Korkmazer E, Solak N, Üstünyurt E. Hysteroscopic assessment of postmenopausal endometrial thickening. Prz Menopauzalny. 2014;13(6):330-3.
Alanis Fuentes J, Martinez Gutlerrez M, Mata M. Hysteroscopy findings in patients with postmenopausal genital bleeding. Ginecol Obs Mex. 2007;75(5):253-8.
Dinic P, Ljubic A, Kopitovic V, Antic V, Stamenovic S, Pjevic A. The role of hysteroscopy in diagnosis and treatment of postmenopausal bleeding. Vojn Pregl. 2013;70(8):1-2.
Loiacono R, Trojano G, Gaudio N, Kardhashi A, Deliso M, Gaetano F, et al. Novel insights from clinical practice hysteroscopy as a valid tool for endometrial pathology in patients with postmenopausal bleeding or asymptomatic patients with a thickened endometrium: hysteroscopic and histological results. Gynecol Obs Invest. 2015;79:210-6.
Tinelli R, Tinelli FG, Cicinelli E, Malvasi A, Tinelli A. The role of hysteroscopy with eye-directed biopsy in postmenopausal women with uterine bleeding and endometrial atrophy. Menopause. 2008;15(4):737-42.
Garuti G, Mirra M, Luerti M. Hysteroscopic view in atypical endometrial hyperplasias: a correlation with pathologic findings on hysterectomy specimens. J Minim Invasive Gynecol. 2006;13:325-30.
Sarvi F, Alleyassin A, Aghahosseini M, Ghasemi M, Gity S. Hysteroscopy: a necessary method for detecting uterine pathologies in post-menopausal women with abnormal uterine bleeding or increased endometrial thickness Histeroskopi. Turk J Obs Gynecol. 2016;13:183-8.
Kanani K, Panchal P, Shah S, Mehta A, Bhagde A. Evaluation of abnormal uterine bleeding by hysteroscopy and curettage. Int J Sci Res. 2017;6(8):417-9.
Valson H, Kulkarni C, Mukerjee S, Gowda SN, Valson H, Contracept JR, et al. The role of diagnostic hysteroscopy in abnormal uterine bleeding and its histopathological correlation following blind dilatation and curettage. Int J Reprod Contracept Obs Gynecol. 2016;5(3):609-14.