Justification of the necessity, value, and role of diagnostic hysteroscopy in the management plan for abnormal uterine bleeding. A teaching hospital experience
- Obstetrics & Gynecology International Journal
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Kamil Mosa Fram, Rand K Fram, Mosa K Fram, Tamer Jalal, Nada Abushalha, Muhran Qlanjiyan, Fadi R Odetallah, Daniel S Azar, Wateen Nabulsi, Imtiyaz Batayha, Farah Hazim, Diana Shahmani, Gadeer Sabateen, Jood Al-Adwan, Tamara Alazzeh, Dana Tawalbeh
Abstract
Aims: The crucial purpose of this study is to pay thoughtfulness to the filmic inspection of the uterine cavity and circumstantial operative amenities have provided the gynecologist with the perfect 'diagnostic' tool, making it conceivable to inspect the cavity and biopsy distrusted areas under direct visualization for patients presented with abnormal uterine bleeding AUB in the perimenopausal or postmenopausal periods.
Materials and methods: We retrospectively reviewed the medical records of 123 perimenopausal and postmenopausal women who presented with abnormal uterine bleeding (AUB) at Jordan University Hospital (JUH) between January 1, 2022, and August 1, 2024. Participants underwent diagnostic hysteroscopy followed by endometrial biopsy. The hysteroscopic findings were compared with the final histopathological diagnoses to evaluate diagnostic accuracy.
Results: In this study of 123 women, clinical indications for hysteroscopy differed by menopausal status, with heavy menstrual bleeding being the most common indication among premenopausal women (74.6%), while postmenopausal bleeding was predominant in postmenopausal women (80.8%). Hysteroscopy revealed a regular uterine cavity in 92.7% of cases, with endometrial abnormalities such as thickened or thin endometrium observed in a significant number of women. Histopathological analysis found normal endometrium in 47.2% of cases, with endometrial polyps (16.3%) and other conditions such as hormonal imbalance and endometritis also frequently noted. A significant relationship was observed between menopausal status and both uterine cavity condition (p = .025) and endometrial state (p = .002), with postmenopausal women more likely to exhibit a thin or abnormal endometrium. The diagnostic value of hysteroscopy was high for fibroids (100% detection) but lower for endometrial polyps (50% detection).
Conclusion: Hysteroscopy must be used as the second-line diagnostic tool after vaginal ultrasound assessment for evaluating the endometrial status in cases of AUB and a necessary step before the decision of surgical removal of the uterus. However, hysteroscopy is not very reliable for ruling out endometrial hyperplasia or cancer in women who have postmenopausal bleeding. Because of this, an endometrial biopsy is crucial for an accurate diagnosis.
Materials and methods: We retrospectively reviewed the medical records of 123 perimenopausal and postmenopausal women who presented with abnormal uterine bleeding (AUB) at Jordan University Hospital (JUH) between January 1, 2022, and August 1, 2024. Participants underwent diagnostic hysteroscopy followed by endometrial biopsy. The hysteroscopic findings were compared with the final histopathological diagnoses to evaluate diagnostic accuracy.
Results: In this study of 123 women, clinical indications for hysteroscopy differed by menopausal status, with heavy menstrual bleeding being the most common indication among premenopausal women (74.6%), while postmenopausal bleeding was predominant in postmenopausal women (80.8%). Hysteroscopy revealed a regular uterine cavity in 92.7% of cases, with endometrial abnormalities such as thickened or thin endometrium observed in a significant number of women. Histopathological analysis found normal endometrium in 47.2% of cases, with endometrial polyps (16.3%) and other conditions such as hormonal imbalance and endometritis also frequently noted. A significant relationship was observed between menopausal status and both uterine cavity condition (p = .025) and endometrial state (p = .002), with postmenopausal women more likely to exhibit a thin or abnormal endometrium. The diagnostic value of hysteroscopy was high for fibroids (100% detection) but lower for endometrial polyps (50% detection).
Conclusion: Hysteroscopy must be used as the second-line diagnostic tool after vaginal ultrasound assessment for evaluating the endometrial status in cases of AUB and a necessary step before the decision of surgical removal of the uterus. However, hysteroscopy is not very reliable for ruling out endometrial hyperplasia or cancer in women who have postmenopausal bleeding. Because of this, an endometrial biopsy is crucial for an accurate diagnosis.
Keywords
abnormal uterine bleeding, endometrial hyperplasia, endometrial cancer, diagnostic hysteroscopy, endometrial biopsy
