Hysteroscopic evaluation of menopausal patients with sonographically atrophic endometrium

Study Objective. To assess the diagnostic and operative potential of hysteroscopy in postmenopausal patients selected by ultrasound criteria. Design. Prospective evaluation (Canadian Task Force classification II-2). Setting. Outpatient ultrasound and hysteroscopy department of a university-affiliate hospital. Patients. Two hundred twelve women with an endometrial thickness less than 4 mm on ultrasound and in menopause for at least 1 year. Interventions. Transvaginal ultrasound and office hysteroscopy, with eye-directed biopsy specimens obtained with a 5-mm, continuous-flow operative hysteroscope, and performed without anesthesia. Measurements and Main Results. Only 13 (6%) patients were symptomatic (irregular bleeding). Hysteroscopic diagnosis of endometrial polyps in three women (23%) was confirmed by histology. In the remaining 199 (94%) asymptomatic patients with atrophic endometrium on ultrasound hysteroscopy showed an endometrial pathology in 10% (16 polyps, 4 submucous myomas); in one patient histologic evaluation disclosed focal adenocarcinoma in an endometrial polyp. Conclusion. Hysteroscopy allows a proper histologic diagnosis, even in asymptomatic postmenopausal women with atrophic endometrium on ultrasound.