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Obstetrics and Gynecology International
Volume 2010, Article ID 850812, 5 pages
http://dx.doi.org/10.1155/2010/850812
Review Article

Diagnostic Strategies for Postmenopausal Bleeding

1Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
2Department Obstetrics and Gynecology, TweeSteden Hospital, Dr. Deelenlaan 5, 5042 AD Tilburg, The Netherlands
3Department Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
4Department Obstetrics and Gynecology, Erasmus MC, s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
5Department Obstetrics and Gynecology, Maxima Medisch Centrum, De Run 4600, 5504 DB Veldhoven, The Netherlands

Received 20 October 2009; Accepted 17 December 2009

Academic Editor: Robert Mclellan

Copyright © 2010 M. C. Breijer et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Postmenopausal bleeding (PMB) is a common clinical problem. Patients with PMB have 10%–15% chance of having endometrial carcinoma and therefore the diagnostic workup is aimed at excluding malignancy. Patient characteristics can alter the probability of having endometrial carcinoma in patients with PMB; in certain groups of patients the incidence has been reported to be as high as 29%. Transvaginal sonography (TVS) is used as a first step in the diagnostic workup, but different authors have come to different conclusions assessing the accuracy of TVS for excluding endometrial carcinoma. Diagnostic procedures obtaining material for histological assessment (e.g., dilatation and curettage, hysteroscopy, and endometrial biopsy) can be more accurate but are also more invasive. The best diagnostic strategy for diagnosing endometrial carcinoma in patients with PMB still remains controversial. Future research should be focussed on achieving a higher accuracy of different diagnostic strategies.