Page 152 - The diagnostic work-up of women with postmenopausal bleeding

Chapter 8
Summary
This thesis studied the diagnostic work-up of women with postmenopausal bleeding (PMB):vaginal bleeding that occurs after a period of 12 months without menstruation at the menopausal age.This chapter summarises the findings of the research we conducted.
Chapter 1 outlines the theoretical background and description of the problem studied in this thesis. Endometrial cancer is defined as cancer from the lining or inside of the uterus (endometrium), and is linked to older age and obesity. As people are living longer and the prevalence of obesity is rising, the incidence of endometrial cancer or pre-cancer (atypical hyperplasia) is expected to rise in the upcoming decades.
In 95% of women, endometrial cancer presents with PMB, mostly at an early stage when curative treatment is still possible. It is therefore considered important to investigate all women who present with PMB. However, only 10% of women with PMB have an underlying diagnosis of endometrial cancer and the most frequent findings are endometrial polyps. Although only sparse evidence is available on this, polyps are believed to be responsible for recurrent bleeding. Consequently, the removal of endometrial polyps is the subject of debate and research.
Diagnostic work-up in women with PMB thus focuses on both the exclusion of endometrial cancer and on the (possible) diagnosis and treatment of endometrial polyps.This thesis studied these two aspects by investigating six research questions. The six research questions and the research conducted in this thesis are explained below.
1. What is already known in the literature about the diagnostic work-up in women with PMB?
Chapter 2 summarises the existing systematic reviews on this subject and provides an overview of different diagnostic tools. Four types of diagnostic tests are described: measurement of endometrial thickness by transvaginal ultrasound (TVS), endometrial sampling (an outpatient biopsy of the lining of the uterus), saline infusion sonography (SIS, an ultrasound in which water or gel installation is used to better visualize the inside of the uterus) and hysteroscopy (inspection of the inside of the uterus with a small camera). All four tests have shown to independently rule out endometrial
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