Outpatient hysteroscopy: indications and hysteroscopic findings in pre- and postmenopausal patients

Objectives We present a large series of outpatient hysteroscopies in order to assess the feasibility of the procedure, the incidence of abnormal findings in pre- and postmenopausal patients and to define a lower age limit for hysteroscopic investigation of patients presenting with abnormal uterine bleeding (AUB). Setting The Endoscopy Clinic of the Rotherham District General Hospital, Rotherham, UK. Subjects 665 patients with a mean age of 47 years. Only patients presenting with abnormal uterine bleeding were included in the study. Interventions 673 outpatient hysteroscopies were carried out; 469 (69%) procedures were done in premenopausal and 204 (31%) in postmenopausal patients. All procedures were done under local anaesthesia with 4-mm rigid hysteroscopes with a 30 degrees objective, using video endoscopy. Results The failure rate was only 6%, i.e. 2.4% in the premenopausal and 11% in the postmenopausal group. The incidence of intrauterine pathology was similar in those patients presenting with intermenstrual bleeding (33%), those presenting with postcoital bleeding (39%), and in those over the age of 40 who presented with menorrhagia (32%). In younger patients (<40 years) with menorrhagia abnormal hysteroscopic findings were seen in 21%, but these were found in only 4% of patients under the age of 30. The lesions in the patients under the age of 40 were mainly uterine fibroids, which can be easily missed using traditional endometrial sampling alone. Uterine fibroids seem to be the commonest lesion in premenopausal patients. Endometrial polyps and endometrial cancer have a peak incidence in patients over the age of 50. Conclusions Outpatient hysteroscopy is a feasible technique in pre- and postmenopausal patients. The high incidence of pathology in post- and premenopausal patients with abnormal uterine bleeding justifies its use in all patients presenting with postmenopausal, intermenstrual and postcoital bleeding, and in patients with menorrhagia over the age of 30.