Page 102 - The diagnostic work-up of women with postmenopausal bleeding

Chapter 5
Table 4. Primary and secondary outcomes
Diagnostic work-up N=98
Expectant management N=100
Relative risk
(95% CI)
Findings at randomisation
Polyps found with hysteroscopy Hyperplasia and atypia Endometrial cancer
Findings during follow-up < 1 year
Recurrent bleeding
Polyps found with recurrent bleeding
Endometrial cancer in recurrent bleeding
Findings during total follow-up
Total recurrent bleeding
Polyps found with recurrent bleeding
Endometrial cancer in recurrent bleeding
Data are n(%), unless otherwise indicated.
50 (51.0) 3 (3.1) 3 (3.1)
15 (15.3) 5 (5.1)
1
20 (20.4) 8 (8.3)
2 (2)
0 0 0
18 (18.0) 12 (12)
0
31 (31) 15 (15)
1(1)
- - - - - -
0.85 (0.46-1.59) 0.43 (0.16-1.19)
- -
0.66 (0.40-1.07) 0.54 (0.24-1.23)
3.10 (0.30-31.98)
In twenty-five out of 51 women (49%) with recurrent bleeding the study protocol was followed and they underwent immediate hysteroscopy.The other 17 women were contacted again after the study was finished and were offered to undergo a hysteroscopy. Finally, four women did not receive further diagnostic work-up: three women refused hysteroscopy and one woman had died due to heart failure two years after randomisation.Further details on the women with recurrent bleeding are provided inTable A2 andTable A3. During follow-up two women in the hysteroscopy group and one woman in the expectant management group were diagnosed with endometrial cancer. Details can be found in the Appendix.
Discussion
Main findings
The results from this multicentre, open label, randomised controlled trial suggest that in women with PMB, a thickened endometrium and a benign result of endometrial sampling, there is no strict indication for hysteroscopy and/or polypectomy to reduce the risk of recurrent bleeding within one year after randomisation.The rate of (pre) cancer in women presenting with recurrent bleeding was comparable in both groups. However, we found a (pre) cancer rate of 6% in women undergoing
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