Out-patient hysteroscopy: findings and decision making for treatment of abnormal uterine bleeding in pre- and post-menopausal women

Objective: To assess the feasibility of outpatient hysteroscopy for identifying abnormal findings in uterine cavities of pre- and postmenopausal women presented with abnormal uterine bleeding (AUB) and how can out-patient hysteroscopy affect the decision making for treatment.
Setting: Erne Hospital, Enniskillen, UK.
Materials and Methods: One hundred and twelve pre- and postmenopausal women presented with AUB. All patients had hysteroscopy as an out-patient procedure. Pipelle suction was used to obtain endometrium for histopathology. Ultrasonography was performed before the patient being seen in the out-patient hysteroscopy clinic.
Results: About half of the women in this study were shown to have normal uterine cavities. The most common abnormal hysteroscopic findings were the endometrial polyps (15.1%) and the submucous fibroids (11.3%). Other findings such as atrophy, hyperplasia and cancer were identified in 8.5%, 8.5% and 1.9% respectively. Sixty nine women (61.6%) with normal and atrophic endometrium went on medical treatment. Polypectomy, removal or insertion of intrauterine uterine contraceptive devices (IUCD) were performed in 14.3%, 3.6% and 4.5% respectively. Thermachoice ablation was performed in 8 patients (7.1%). Major surgical intervention in the form of abdominal hysterectomy was decided in 9% of cases.
Conclusions: Out-patient hysteroscopy is a feasible technique in identifying abnormal uterine findings in cases of AUB in pre- and post menopausal women. Based on hysteroscopic findings, accurate diagnosis of the cause of AUB can be made and subsequently the appropriate decision regarding different treatment options can be chosen.