Page 101 - The diagnostic work-up of women with postmenopausal bleeding

Women with a missed diagnosis of a (pre) cancer after endometrial sampling had a significantly thicker endometrium (12 versus 8 mm (p=0.02) and a higher BMI (35.9 versus 27.5 (p=0.008)) compared to women with a true negative result of endometrial sampling.The patient characteristics of these women are detailed in the Appendix and Table A1.
Figure 2: Kaplan-Meier curves for time to recurrent bleeding in women after diagnostic work-up or expectant management.
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Diagnostic work-up: a RCT
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Time to recurrent bleeding (week)
Randomisation outcome
="SIS and hysteroscopy" ="expectant management"
Recurrent bleeding within 12 months occurred in 15 women (15.3%) after hysteroscopy and in 18 women (18.0%) after expectant management (RR 0.85; 95% CI 0.4-1.6) (Table 4). Follow-up varied between 12 and 56 months, with a median follow-up of 14 months in both groups. Figure 2 shows the Kaplan-Meier curve for time to recurrent bleeding.The mean time to recurrent bleeding after hysteroscopy was 34.5 weeks (95% CI 30-39) versus 30.1 weeks (95% CI 26-34) after expectant management (log-rank test p=0.20).Table 4 shows no statistical differences in the number of polyps and carcinomas found at recurrent bleeding between the women in the hysteroscopy group or the women in the expectant management group.
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Risk of recurrent bleeding