OBJECTIVES: Determine the effectiveness of hysteroscopic surgery in persistent postmenopausal bleeding. PATIENTS AND METHODS: Transcervical resection was performed in 176 women between the ages of 46-74 years. A benign cause was noted in 135 cases (polyps in 80 and submucous fibroids in 55); 37 patients had no significant disease and 4 had endometrial atypical hyperplasia missed in the preoperative evaluation. Patients underwent resection of polyp, resection of fibroid or endometrial ablation. Major operative complications were rare and included 3 perforations and one case of fluid overload. Patients were followed for 1-10 years after treatment (mean follow-up 52 months). RESULTS: 167 patients completed the study. Clinical manifestations disappeared in 85.2% of the patients; 15 patients had hysterectomy after the hysteroscopic procedure and 11 had repeat transcervical resection. CONCLUSION: Hysteroscopic treatment can be effective in carefully selected patients with postmenopausal bleeding or abnormal uterine bleeding on hormone replacement therapy. The operative criteria should take the causes of bleeding and not just the age of patient into account.
Hysteroscopic surgery for the treatment of persistent postmenopausal bleeding
PINELLI, Leonardo;
1998-01-01
Abstract
OBJECTIVES: Determine the effectiveness of hysteroscopic surgery in persistent postmenopausal bleeding. PATIENTS AND METHODS: Transcervical resection was performed in 176 women between the ages of 46-74 years. A benign cause was noted in 135 cases (polyps in 80 and submucous fibroids in 55); 37 patients had no significant disease and 4 had endometrial atypical hyperplasia missed in the preoperative evaluation. Patients underwent resection of polyp, resection of fibroid or endometrial ablation. Major operative complications were rare and included 3 perforations and one case of fluid overload. Patients were followed for 1-10 years after treatment (mean follow-up 52 months). RESULTS: 167 patients completed the study. Clinical manifestations disappeared in 85.2% of the patients; 15 patients had hysterectomy after the hysteroscopic procedure and 11 had repeat transcervical resection. CONCLUSION: Hysteroscopic treatment can be effective in carefully selected patients with postmenopausal bleeding or abnormal uterine bleeding on hormone replacement therapy. The operative criteria should take the causes of bleeding and not just the age of patient into account.
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