Flexible hysteroscopy: an outpatient evaluation in abnormal uterine bleeding

Abstract

ObjectiveTo investigate the value of including flexible hysteroscopy as an investigative procedure as part of a one‐stop outpatient clinic for the investigation of abnormal uterine bleeding.DesignA prospective study comparing the information obtained at outpatient hysteroscopy with that detected by gynaecological examination and undirected endometrial biopsy. Transvaginal ultrasound was used as an adjunct to these investigations and no formal comparison was made per se between this and hysteroscopy.SettingThe Abnormal Uterine Bleeding (AUB) Clinic, The Royal Surrey County Hospital, Guildford 1991–1996.SubjectsThese were 1022 women (age range 18–86 years) referred by their general practitioners because of abnormal uterine bleeding. No other referral criteria, such as age, were enforced.Main outcome measuresIncidence of benign and malignant gynaecological pathology.ResultsThe true failure rate where hysteroscopy was indicated and attempted was 2.7%. No significant pathology was identified in any patient under the age of 25 years. The incidence of confirmed malignancy was 6.84 per 1000. The percentage of the total pathology identified by hysteroscopy alone, in the age group 35–39 years, was 37 out of 65 abnormalities (56.9%). This was significantly greater than in the age group 25–34 years (P = 0.017), where 16 out of 47 abnormalities (34.0%) were identified. There was no significant difference between the 35–39 and the 40–89‐years age group (P = 0.078) in which hysteroscopy identified 224 out of 494 abnormalities (45.3%).ConclusionFlexible hysteroscopy applied on an outpatient basis is a simple and safe investigation, acceptable to patients, which greatly enhances the detection and characterization of intrauterine pathology allowing appropriately directed treatment options. In our series the incidence of intrauterine adhesions was 1.5%, endometrial polyps 13.7%, and submucous fibroids 14.6%. We would recommend that: hysteroscopy should not be performed on women under 25 years of age; outpatient hysteroscopy should be offered as a first‐line investigation to all women over the age of 35 years presenting with abnormal uterine bleeding.