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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.

Linked References

  1. T. J. Clark, P. M. Barton, A. Coomarasamy, J. K. Gupta, and K. S. Khan, “Investigating postmenopausal bleeding for endometrial cancer: cost-effectiveness of initial diagnostic strategies,” BJOG, vol. 113, no. 5, pp. 502–510, 2006. View at Publisher · View at Google Scholar · View at Scopus
  2. F. P. Dijkhuizen, Diagnosis of Uterine Cavity Abnormalities. Studies on Test Performace and Clinical Value, Utrecht University, Utrecht, The Netherlands, 2000.
  3. K. Astrup and N. D. F. Olivarius, “Frequency of spontaneously occurring postmenopausal bleeding in the general population,” Acta Obstetricia et Gynecologica Scandinavica, vol. 83, no. 2, pp. 203–207, 2004. View at Publisher · View at Google Scholar · View at Scopus
  4. C. T. Escoffery, G. O. Blake, and L. A. Sargeant, “Histopathological findings in women with postmenopausal bleeding in Jamaica,” West Indian Medical Journal, vol. 51, no. 4, pp. 232–235, 2002. View at Google Scholar · View at Scopus
  5. T. Gredmark, S. Kvint, G. Havel, and L. A. Mattsson, “Histopathological findings in women with postmenopausal bleeding,” British Journal of Obstetrics and Gynaecology, vol. 102, no. 2, pp. 133–136, 1995. View at Google Scholar · View at Scopus
  6. W. H. Lee, K. H. Tan, and Y. W. Lee, “The aetiology of postmenopausal bleeding–a study of 163 consecutive cases in Singapore,” Singapore Medical Journal, vol. 36, no. 2, pp. 164–168, 1995. View at Google Scholar · View at Scopus
  7. A. Lidor, B. Ismajovich, E. Confino, and M. P. David, “Histopathological findings in 226 women with post-menopausal uterine bleeding,” Acta Obstetricia et Gynecologica Scandinavica, vol. 65, no. 1, pp. 41–43, 1986. View at Google Scholar · View at Scopus
  8. H. H. Lin, M. Y. Wu, M. K. Shyu, D. Chen, J. L. Tsai, and C. Y. Hsieh, “Clinical study of 381 postmenopausal bleeding patients,” Journal of the Formosan Medical Association, vol. 92, no. 3, pp. 241–244, 1993. View at Google Scholar · View at Scopus
  9. E. Epstein, A. Ramirez, L. Skoog, and L. Valentin, “Dilatation and curettage fails to detect most focal lesions in the uterine cavity in women with postmenopausal bleeding,” Acta Obstetricia et Gynecologica Scandinavica, vol. 80, no. 12, pp. 1131–1136, 2001. View at Publisher · View at Google Scholar · View at Scopus
  10. A. Timmermans, M. B. Gerritse, B. C. Opmeer, F. W. Jansen, B. W. Mol, and S. Veersema, “Diagnostic accuracy of endometrial thickness to exclude polyps in women with postmenopausal bleeding,” Journal of Clinical Ultrasound, vol. 36, no. 5, pp. 286–290, 2008. View at Google Scholar
  11. D. M. Parkin, F. Bray, J. Ferlay, and P. Pisani, “Estimating the world cancer burden: globocan 2000,” International Journal of Cancer, vol. 94, no. 2, pp. 153–156, 2001. View at Publisher · View at Google Scholar · View at Scopus
  12. E. Epstein, “Management of postmenopausal bleeding in Sweden: a need for increased use of hydrosonography and hysteroscopy,” Acta Obstetricia et Gynecologica Scandinavica, vol. 83, no. 1, pp. 89–95, 2004. View at Publisher · View at Google Scholar · View at Scopus
  13. R. B. Goldstein, R. L. Bree, C. B. Benson et al., “Evaluation of the woman with postmenopausal bleeding: society of radiologists in ultrasound-sponsored consensus conference statement,” Journal of Ultrasound in Medicine, vol. 20, no. 10, pp. 1025–1036, 2001. View at Google Scholar · View at Scopus
  14. NVOG (Dutch Society of Obstetrics and Gynaecology), “NVOG-richtlijn Abnormaal Vaginaal Bloedverlies in de Menopauze,” [in Dutch]. 2003.
  15. Scottish Intercollegiate Guidelines Network, Investigation of Postmenopausal Bleeding, 2002.
  16. J. K. Gupta, P. F. W. Chien, D. Voit, T. J. Clark, and K. S. Khan, “Ultrasonographic endometrial thickness for diagnosing endometrial pathology in women with postmenopausal bleeding: a meta-analysis,” Acta Obstetricia et Gynecologica Scandinavica, vol. 81, no. 9, pp. 799–816, 2002. View at Publisher · View at Google Scholar · View at Scopus
  17. R. Smith-Bindman, K. Kerlikowske, V. A. Feldstein et al., “Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities,” Journal of the American Medical Association, vol. 280, no. 17, pp. 1510–1517, 1998. View at Publisher · View at Google Scholar · View at Scopus
  18. A. Tabor, H. C. Watt, and N. J. Wald, “Endometrial thickness as a test for endometrial cancer in women with postmenopausal vaginal bleeding,” Obstetrics and Gynecology, vol. 99, no. 4, pp. 663–670, 2002. View at Publisher · View at Google Scholar · View at Scopus
  19. B. Y. De Silva, K. Stewart, J. D. Steven, and M. Sathanandan, “Transvaginal ultrasound measurement of endometrial thickness and endometrial pipelle sampling as an alternative diagnostic procedure to hysteroscopy and dilatation and curettage in the management of post-menopausal bleeding,” Journal of Obstetrics and Gynaecology, vol. 17, no. 4, pp. 399–402, 1997. View at Publisher · View at Google Scholar · View at Scopus
  20. O. Grigoriou, A. Kalovidouros, C. Papadias, G. Antoniou, V. Antonaki, and L. Giannikos, “Transvaginal sonography of the endometrium in women with postmenopausal bleeding,” Maturitas, vol. 23, no. 1, pp. 9–14, 1996. View at Publisher · View at Google Scholar · View at Scopus
  21. J. K. Gupta, S. Wilson, P. Desai, and C. Hau, “How should we investigate women with postmenopausal bleeding?” Acta Obstetricia et Gynecologica Scandinavica, vol. 75, no. 5, pp. 475–479, 1996. View at Google Scholar · View at Scopus
  22. M. N. Nasri and G. J. Coast, “Correlation of ultrasound findings and endometrial histopathology in postmenopausal women,” British Journal of Obstetrics and Gynaecology, vol. 96, no. 11, pp. 1333–1338, 1989. View at Google Scholar · View at Scopus
  23. L. C. van Doorn, F. P. Dijkhuizen, R. F. Kruitwagen, A. P. Heintz, G. S. Kooi, and B. W. Mol, “Accuracy of transvaginal ultrasonography in diabetic or obese women with postmenopausal bleeding,” Obstetrics & Gynecology, vol. 104, no. 3, pp. 571–578, 2004. View at Google Scholar
  24. R. J. Stock and A. Kanbour, “Prehysterectomy curettage,” Obstetrics & Gynecology, vol. 45, no. 5, pp. 537–541, 1975. View at Google Scholar
  25. C. P. Spencer and M. I. Whitehead, “Endometrial assessment re-visited,” British Journal of Obstetrics and Gynaecology, vol. 106, no. 7, pp. 623–632, 1999. View at Google Scholar
  26. F. P. Dijkhuizen, B. W. J. Mol, H. A. M. Brölmann, and A. P. Heintz, “The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: a meta-analysis,” Cancer, vol. 89, no. 8, pp. 1765–1772, 2000. View at Google Scholar · View at Scopus
  27. H. C. van Doorn, B. C. Opmeer, C. W. Burger, M. J. Duk, G. S. Kooi, and B. W. Mol, “Inadequate office endometrial sample requires further evaluation in women with postmenopausal bleeding and abnormal ultrasound results,” International Journal of Gynecology & Obstetrics, vol. 99, no. 2, pp. 100–104, 2007. View at Google Scholar
  28. R. J. Gimpelson and H. O. Rappold, “A comparative study between panoramic hysteroscopy with directed biopsies and dilatation and curettage: a review of 276 cases,” American Journal of Obstetrics and Gynecology, vol. 158, no. 3, part 1, pp. 489–492, 1988. View at Google Scholar · View at Scopus
  29. F. D. Loffer, “Hysteroscopy with selective endometrial sampling compared with D&C for abnormal uterine bleeding: the value of a negative hysteroscopic view,” Obstetrics & Gynecology, vol. 73, no. 1, pp. 16–20, 1989. View at Google Scholar
  30. S. Bettocchi and L. Selvaggi, “A vaginoscopic approach to reduce the pain of office hysteroscopy,” Journal of the American Association of Gynecologic Laparoscopists, vol. 4, no. 2, pp. 255–258, 1997. View at Google Scholar
  31. S. Bettocchi, L. Nappi, O. Ceci, and L. Selvaggi, “What does ‘diagnostic hysteroscopy’ mean today? The role of the new techniques,” Current Opinion in Obstetrics and Gynecology, vol. 15, no. 4, pp. 303–308, 2003. View at Google Scholar
  32. K. E. Anderson, E. Anderson, P. J. Mink et al., “Diabetes and endometrial cancer in the Iowa Women's Health Study,” Cancer Epidemiology Biomarkers and Prevention, vol. 10, no. 6, pp. 611–616, 2001. View at Google Scholar · View at Scopus
  33. B. Gull, B. Karlsson, I. Milsom, and S. Granberg, “Factors associated with endometrial thickness and uterine size in a random sample of postmenopausal women,” American Journal of Obstetrics and Gynecology, vol. 185, no. 2, pp. 386–391, 2001. View at Publisher · View at Google Scholar · View at Scopus
  34. C. P. McPherson, T. A. Sellers, J. D. Potter, R. M. Bostick, and A. R. Folsom, “Reproductive factors and risk of endometrial cancer. The Iowa Women's Health Study,” American Journal of Epidemiology, vol. 143, no. 12, pp. 1195–1202, 1996. View at Google Scholar
  35. E. Weiderpass, I. Persson, H. O. Adami, C. Magnusson, A. Lindgren, and J. A. Baron, “Body size in different periods of life, diabetes mellitus, hypertension, and risk of postmenopausal endometrial cancer (Sweden),” Cancer Causes and Control, vol. 11, no. 2, pp. 185–192, 2000. View at Publisher · View at Google Scholar · View at Scopus
  36. W. H. Xu, Y. B. Xiang, Z. X. Ruan et al., “Menstrual and reproductive factors and endometrial cancer risk: results from a population-based case-control study in urban Shanghai,” International Journal of Cancer, vol. 108, no. 4, pp. 613–619, 2004. View at Publisher · View at Google Scholar · View at Scopus
  37. B. C. Opmeer, H. C. van Doorn, A. P. Heintz, C. W. Burger, P. M. Bossuyt, and B. W. Mol, “Improving the existing diagnostic strategy by accounting for characteristics of the women in the diagnostic work up for postmenopausal bleeding,” BJOG, vol. 114, no. 1, pp. 51–58, 2007. View at Google Scholar
  38. K. S. Khan, L. M. Bachmann, and G. ter Riet, “Systematic reviews with individual patient data meta-analysis to evaluate diagnostic tests,” European Journal of Obstetrics Gynecology and Reproductive Biology, vol. 108, no. 2, pp. 121–125, 2003. View at Publisher · View at Google Scholar · View at Scopus
  39. I. Bruchim, T. Biron-Shental, M. M. Altaras et al., “Combination of endometrial thickness and time since menopause in predicting endometrial cancer in women with postmenopausal bleeding,” Journal of Clinical Ultrasound, vol. 32, no. 5, pp. 219–224, 2004. View at Publisher · View at Google Scholar · View at Scopus
  40. L. M. Bachmann, G. ter Riet, T. J. Clark, J. K. Gupta, and K. S. Khan, “Probability analysis for diagnosis of endometrial hyperplasia and cancer in postmenopausal bleeding: an approach for a rational diagnostic workup,” Acta Obstetricia et Gynecologica Scandinavica, vol. 82, no. 6, pp. 564–569, 2003. View at Publisher · View at Google Scholar · View at Scopus
  41. A. Timmermans, S. Veersema, T. C. van Kerkvoorde et al., “Should endometrial polyps be removed in patients with postmenopausal bleeding?–an assessment of study designs and report of a failed randomised controlled trial (ISRCTN73825127),” BJOG, vol. 116, no. 10, pp. 1391–1395, 2009. View at Publisher · View at Google Scholar · View at Scopus
  42. K. A. Broeze, B. C. Opmeer, L. M. Bachmann et al., “Individual patient data meta-analysis of diagnostic and prognostic studies in obstetrics, gynaecology and reproductive medicine,” BMC Medical Research Methodology, vol. 9, article 22, 2009. View at Publisher · View at Google Scholar
  43. E. Leushuis, J. W. van der Steeg, P. Steures et al., “Prediction models in reproductive medicine: a critical appraisal,” Human Reproduction Update, vol. 15, no. 5, pp. 537–552, 2009. View at Publisher · View at Google Scholar · View at Scopus
  44. A. P. Davies, I. Jacobs, R. Woolas, A. Fish, and D. Oram, “The adnexal mass: benign of malignant? Evaluation of a risk of malignancy index,” British Journal of Obstetrics and Gynaecology, vol. 100, no. 10, pp. 927–931, 1993. View at Google Scholar · View at Scopus