Page 98 - The diagnostic work-up of women with postmenopausal bleeding

Chapter 5
Table 1. Baseline characteristics
Age, years; median (IQR)
Age at menopause, years; median (IQR) Years since menopause; median (IQR) BMI, kg/m2; median (IQR)
Endometrial thickness, mm; median (IQR) Endometrial thickness measurable (%) Episodes of bleeding
Single (%)
Multiple (%) Multipara (%) Hormonal therapy
At this moment (%)
In the past (%) Anticoagulants
Aspirin (%) Diabetes
with oral medication (%) with insulin (%)
No medication (%)
Hyper tension
With medication (%) Without medication (%)
Result endometrial sampling
Benign (%)
Polyp (%)
Simple hyperplasia (%)
Complex hyperplasia (without atypia) (%)
Abnormal Pap-smear (%) IQR: Interquartile range
57 (54-62) 51 (48-53)
5 (2-12) 28.0 (24.3-32.7) 8 (6-12)
93 (95)
66 (67.3) 32 (32.7) 87 (88.8)
5 (5.1) 10 (10.2) 8 (8.1) 6 (6.1) 7 (7.1) 4 (57.1) 3 (42.9) 0 (0.0) 31 (31.6) 30 (96.8) 1 (3.2)
78 (79.6) 14 (14.3) 5 (5.1) 1 (1.0)
4 (4.4)
56 (52-61) 50 (48-52)
5 (2-11) 28.7 (25.2-35.0) 7 (6-10) 100 (98)
77 (75.5) 25 (24.5) 93 (91.2)
1 (1.0)
8 (7.8) 10 (9.8) 6 (5.9) 7 (6.9) 4 (57.1) 2 (28.6) 1 (14.3) 34 (33.3) 32 (94.1) 2 (5.9)
86 (84.3) 9 (8.8) 7 (6.9) 0
3 (3.0)
Diagnostic work-up (SIS and hysteroscopy) (n = 98)
Expectant management (n = 102)
Figure 1 and table 2 show the findings of SIS (n=81) and hysteroscopy (n=87). In two women SIS was not possible due to pain. SIS showed a polyp in 40 women, no polyp in 33 women and was inconclusive in six women. Among these 6 women, hysteroscopy showed a benign polyp in five and one of these showed atypical hyperplasia at pathology. In the other 73 women, hysteroscopy failed in one, while a polyp was found in 41 of the 72 (57%). The sensitivity of SIS to diagnose an endometrial polyp was 93% (95% CI 0.81-0.98) for a specificity of 94% (95% CI 0.78-0.99).18
96