Page 76 - The diagnostic work-up of women with postmenopausal bleeding

Chapter 4
between November 2002 and June 2009. Menopause was defined as at least one year of amenorrhea after the age of 40.The following patient characteristics were recorded: age, age at menopause, weight, height, parity, HRT use, hypertension, diabetes, use of anticoagulants and endometrial thickness measured by TVS. If endometrial thickness exceeded 4.4 mm, saline infused sonography (SIS) was performed. If there were no focal lesions in the uterine cavity at SIS, an endometrial sample using the Endorette® (Medscan AB, Malmö, Sweden) was taken. If there were focal lesions at SIS or if SIS failed, hysteroscopy with resection of focal lesions (if present) and supplementary dilatation and curettage were performed.15 Women in whom endometrial sampling was not performed because of endometrium < 4.4 mm were instructed to contact the hospital if recurrence of bleeding occurred.
Follow-up in the Dutch database was based on data collected from case notes. For the purpose of this study, all women with an endometrial thickness below the cut-off value, who did not have endometrial sampling without recurrent bleeding, were considered negative for endometrial cancer. In case of recurrent bleeding, hysteroscopy was performed.The median follow-up time in this database was 26 months (range 18 to 43 months).
In the Swedish database, all women with an endometrial thickness < 4.4 mm (and therefore without a histological diagnosis of the endometrium) were matched with the regional cancer register to ascertain that none of these women were diagnosed with endometrial cancer after inclusion in the study. Indeed, no woman with endometrial thickness < 4.4 mm was found to have endometrial cancer and all were classified as not having endometrial cancer.
Women were excluded from our statistical analysis if the endometrial thickness was not measurable.The Swedish database does not include women with fluid in the uterine cavity. Precancer, defined as any form of hyperplasia with atypia, and cancer in the histology specimen were classified as ‘endometrial cancer’. All other histological diagnoses were classified as benign.
Statistical analysis of patient characteristics
We compared patient characteristics between the two databases with the chi-square test. Continuous variables were tested for normal distribution, and the independent
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