The value of outpatient hysteroscopy in diagnosing endometrial pathology in postmenopausal women with and without hormone replacement therapy

Background. This study examined the endometrial pathology in postmenopausal women who had experienced abnormal uterine bleeding, both with and without hormone replacement therapy (HRT), and who subsequently underwent outpatient hysteroscopy. Methods. This is a retrospective observational and comparative study. Patient data in the period from 1998 to 2001 inclusive were examined. The influence of various factors on the incidence of pathology was determined, for example HRT use, the type of HRT, age, etc. In addition, the reliability of hysteroscopy in identifying pathology was calculated. Results. A total of 503 patients presented with postmenopausal bleeding, 299 postmenopausal women and 204 women on HRT. The incidence of endometrial carcinoma was significantly higher in the postmenopausal women not on HRT (RR>10), and occurred in women who were significantly older (p=0.003). Other forms of pathology, such as complex hyperplasia, benign endometrial polyps and fibroids, did not significantly differ between the groups. Outpatient hysteroscopy correctly identified endometrial carcinoma in 98.2% of cases; however, it was less reliable in diagnosing other forms of pathology. Conclusions. The relative risk of a postmenopausal woman presenting to a hysteroscopy clinic with abnormal bleeding caused by endometrial cancer is more than 10 times the risk of an HRT counterpart. Furthermore, both hysteroscopy and pipelle sampling are required to accurately identify all cases of endometrial carcinoma.