Outpatient Endometrial Sampling As The Sole Primary Method For Assessing Abnormal Uterine Bleeding In Women Over 35 Years In Trinidad

Abstract

Formal dilatation and curettage (D&C) is commonly used in developing countries as the standard and often sole means of assessing abnormal uterine bleeding in women of middle and advanced age. This is counterproductive in countries with limited resources. 102 such women >35 years of age were investigated using endometrial sampling as an outpatient (ESOP) as the sole primary method. An algorithm was developed to allow for further investigation in cases of failed sampling or continuing symptoms. Histological diagnoses were obtained in 68.6% of patients, and of 32 instances with inadequate or no sample, 22 were endometrial polyps. One report of an inadequate sample proved to be endometrial hyperplasia on further investigation. Since ESOP, assessed alongside other diagnostic modalities, has previously been shown to be as accurate as D&C in detecting endometrial pathology, our experience confirms its role as a valuable and inexpensive means of first line assessment in developing countries. This policy would obviate the need for further investigation in approximately 70% of these women and only the other 30% would proceed to further methods, thus resulting in cost savings. However, endometrial polyps would be commonly missed.