P30.01: Hysteroscopy and vaginal ultrasound in endometrium evaluation in postmenopause bleeding

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The aim of this study was to compare the efficacy of blind endometrial biopsy by Pipelle with that of hysteroscopic biopsy with biopsy forceps under direct view. The study included 69 postmenopausal women in the gynecology department of the “Dr. I. Cantacuzino” Hospital selected for endometrial biopsy because of irregular bleedings in menopause or for endometrial thickness 4-6 mm evaluated by transvaginal ultrasound. All women were between 45 and 62 years, at least after one year without any menstrual bleedings and without hormonal therapy. All women undergo biopsy with Pipelle and in 36 cases the results indicated endometrial hyperplasia, 27 with atrophy, 4 polyps and 2 cases with insufficient tissue sample. The hysteroscopy was performed after 4 weeks from the first biopsy, and enabled a selective biopsy of the areas of visualized endometrium. The results were 42 hyperplasia, 16 polyps and 11 atrophic endometrium. The rate of confirmation rate for polyps by Pipelle was 1 to 4, the rest of 12 polyps were initially considered atrophy or hyperplasia without atypia (3 cases). Also, 9 cases of initially considered atrophy were discovered with simple hyperplasia without athypia, and in 7 cases of simple hyperplasia it was discovered a complex hyperplasia without athypia. The conformity rate calculated by analysis between blind and under direct visual control biopsy for hyperplasic endometrium was 88,31%. Hysteroscopic biopsy under visual control is necessary at least for the patients with any hyperplasic changes at the blind biopsy. Ultrasound may be helpful if it is any suspicion of the intrauterine polyp.