UTERINE BLEEDING IN POSTMENOPAUSAL WOMEN – THE ROLE OF HYSTEROSCOPY

Problem statement: Uterine bleeding (UB) is one of the most common symptoms in gynaecological practice. Hysteroscopy is commonly considered the gold standard technique for the endometrium evaluation, allowing a direct view of the uterine cavity as well as diagnostic and therapeutic procedures.The aim of this study was to evaluate the role of hysteroscopy in the diagnosis of endometrial pathology and its relation to postmenopausal UB.Methods: Retrospective study, including postmenopausal women with thickened endometrium (>4mm) diagnosed by transvaginal ultrasound, who were submitted to hysteroscopy in Braga’s Hospital, between January and December 2018. The sample was divided into two groups: without UB (G1); with UB (G2). Sensitivity, specificity and accuracy of hysteroscopy were evaluated. Histological findings were classified as normal if they were atrophic or lightly proliferative; benign in cases of endometrial polyps, myomas, endometritis, adenomyosis or endometrial hyperplasia; and malignant if endometrial cancer. Descriptive and analytic evaluation was performed with SPPS and sensitivity, specificity and concordance coefficient (k) was calculated (p0.05). Hypertensive disorders were more common in G2 (33.3% vs. 50.7%; p=0.04). No differences were found between the groups regarding age of menopause, body mass index, parity, hormonal replacement therapy or tamoxifen use. In hysteroscopy evaluation, polyps were the most common pathology in both groups but significantly more frequent in G1 (58.7% vs 34.4%, p=0.01). Overall rate of malignancy was 7.9%, but all cases had UB (0 vs. 18.6%, p<0.001). Malignancy was also significantly associated with a greater endometrial thickness when compared to benign pathology (12.3mm vs 26.2mm; p=0.01). For benign pathology, global hysteroscopy sensitivity was 97.9% and specificity 80.0%. For malignancy sensitivity was 91.6% and specificity was 99.5%. Kappa concordance coefficient for benign pathology was 0.76 for G1 and 0.88 in G2, and for malignancy was, respectively, 0.76 and 0.87.Conclusions: Uterine bleeding is strongly associated with endometrial malignancy. Hysteroscopy is a valuable and minimally invasive procedure that can improve diagnostic accuracy of endometrial pathology.