Presence Of Endometrial Polyps Research Articles

Exploring the role of serum sestrin 2 in patients with endometrial polyps and uterine leiomyomas: implications for early diagnosis and pathophysiology

Endometrial polyps and uterine leiomyomas are common gynecological conditions that significantly affect women's health. Recent studies have begun to explore potential biomarkers that could assist in the early diagnosis and understanding of the pathophysiology of these conditions. One such biomarker is Serum Sestrin 2 (SESN2), a protein involved in cellular stress response. This review aims to synthesize research findings on the relationship between serum SESN2 levels and the presence of endometrial polyps and uterine leiomyomas. It examines the potential of SESN2 as a diagnostic tool and its role in the underlying mechanisms of these conditions. Studies suggest that SESN2 levels are elevated in patients with these conditions compared to controls, indicating its involvement in their pathophysiology. Furthermore, the review discusses the implications of these findings for clinical practice, particularly in terms of early detection and targeted therapies. Future research directions and the need for large-scale studies to validate SESN2 as a clinical marker are also addressed. This review highlights the importance of biomarkers like SESN2 in enhancing our understanding and management of gynecological disorders.

Evaluation of Comt2, Comt3, Cyp1b1, and Esr1 gene polymorphisms as risk factor for endometrial polyp

ABSTRACT The aim of this study is to evaluate COMT2, COMT3, CYP1B1, and ESR1 gene polymorphisms and occurrence of endometrial polyps. In addition, we intended to evaluate the clinical and epidemiological features of patients with and without the presence of the disease, characterizing the possible risk factors. A cross-sectional study was performed, with a total of 309 women, including 236 in the group of women with endometrial polyp confirmed by hysteroscopy and anatomical pathological examination and 73 in the group of people with diagnostic hysteroscopy without abnormal findings from the macroscopic point of view. Polymorphisms of four genes were studied: COMT2 (rs4680), COMT3 (rs5031015), CYP1B1 (rs1056836), and ESR1 (rs2234693). Polymorphism genotyping was determined using real-time polymerase chain reaction. Considering the results, no differences were identified between the two groups with respect to age, body mass index, diabetes, dyslipidemia, or smoking. The group of women without endometrial polyps showed higher use of hormone therapy than the other group (16.4 percent versus 3.8 percent, p < .001). The COMT2, COMT3, CYP1B1, and ESR1 genes exhibited no significant difference for the occurrence of endometrial polyp between the two groups. The research concluded that no correlation was identified between the genetic polymorphisms evaluated and the presence of endometrial polyps.

The association between endometrial polyps, chronic endometritis, and IVF outcomes.

Endometrial polyps (EPs) are one of the most common pathologies detected during the examination of the uterine cavity of infertile women. We aimed to demonstrate the relationship between EPs, chronic endometritis (CE) and in vitro fertilization (IVF) outcomes. This retrospective study was performed on 394 hysteroscopically examined infertility cases. We performed polyp resections (PR) and extensive biopsies of the endometrium to demonstrate the association with clinical pregnancy (CP) by IVF. We performed statistical analysis to compare these associations. The incidence of CE was twice as high in the presence of EPs as in the absence of EPs. The associations between EPs and PR were found to be significant for positive CP outcomes. A significant difference in IVF outcome was found between the group with EPs and the group without EPs. All these associations were statistically significant (p < 0.05). We found a frequent association between EPs and CE. The pregnancy rate obtained after IVF was negatively affected by the presence of EPs. Treatment of these pathologies improved IVF outcomes.

Accuracy of Endometrial Biopsy in Diagnosing Endometrial Polyps [ID: 1343431

INTRODUCTION: Endometrial polyps are commonly reported on endometrial biopsies, but accuracy remains uncertain. The purpose of this study was to determine the positive predictive value (PPV) of endometrial polyp findings on endometrial biopsy. METHODS: In this retrospective cohort study, we screened 1,403 patients with endometrial biopsies that indicated presence of endometrial polyp between 2010 and 2020. Patients with concurrent endometrial cancer were excluded. Of the remaining patients, 546 had a subsequent gold-standard (GS) procedure (440 with hysteroscopy and 106 with hysterectomy) and were enrolled. Pathology results of GS procedures were analyzed for confirmation of endometrial polyp, and hysteroscopy operative reports were reviewed to determine intraoperative polyp visualization. RESULTS: Of the 546 patients whose endometrial biopsy reported endometrial polyp, 391 had endometrial polyp confirmed on GS pathology for a PPV of 71.6% (95% CI 67.6–75.4). Of the 440 patients who had hysteroscopy, 351 had endometrial polyp on pathology for a PPV of 79.8% (95% CI 75.7–83.4). Only 292 of the 440 hysteroscopy patients, however, had a polyp visualized by the surgeon, for a PPV of 66.4% (95% CI 61.7–70.8) when based on operative findings. Patients with a polyp on GS pathology were more likely to be postmenopausal (P=.001), have obesity (body mass index &gt;30) (P=&lt;.001), diabetes (P=.015), and hypertension (P=.037). There was no difference based on patient race (P=.182), hormonal therapy use (P=.295), or tamoxifen use (P=.127). Patients with thicker endometrial linings on ultrasound were more likely to have a polyp on GS pathology (P=.002), but uterine cavity length did not affect the PPV (P=.415). CONCLUSION: Endometrial biopsy correctly predicted the diagnosis of endometrial polyp in 72% of cases based on subsequent GS procedures, with the remaining 28% being false positives. Endometrial biopsy was more likely to accurately diagnose endometrial polyps in patients who were postmenopausal, had certain comorbid conditions, and had thicker endometrial linings.

Effects of uterine polyps on embryo implantation in IVF cycles

Embryo implantation requires healthy uterine endometrium for natural or assisted reproductive technology conception. However, in presence of any endometrial anatomical abnormality or disease, implantation is affected. Uterine or endometrial polyps are over growths of endometrial cells that extend into the uterine cavity. They are usually noncancerous. There can be one or many polyps. They range in size from a few millimeters to several centimeters or larger. They may cause vaginal bleeding in between periods, heavy periods, frequent or unpredictable periods and infertility. The objective of this study was to find out effects of endometrial polyps on embryo implantation in assisted reproductive technology cycles of Saudi women being treated at an infertility clinic. This was a case-control study. The participants were in ratio of 5:1 i.e., for every 5 patients there was one control. The polyp diagnosis was carried out with ultrasound and endometrial biopsy. We observed high incidence of implantation failure in patients with uterine polyps as compared to that in the control patients. The results of this study indicated that the presence of endometrial polyps is a risk factor for infertility and failure of conception after in vitro fertilization.

Can endometrial thickness at baseline or maximum stimulated levels during IVF predict the presence of endometrial polyps in women with two failed embryo transfers?

To evaluate whether different measurements of endometrial thickness pre-IVF cycle and during the IVF cycles as measured by transvaginal ultrasound are associated with the absence or presence of endometrial polyps. A retrospective cohort study was conducted in a university-affiliated fertility center. Patients were women who underwent two embryo transfer cycles and failed to conceive. hysteroscopic evaluation and resection of any masses. There was no difference on comparing the groups with and without polyps in the mean endometrial thicknesses at baseline scans pre-treatment or during IVF cycle. For women who failed two embryo transfer cycles, at any given endometrial thickness the probability of the presence of a polyp was 30-40%. ROC curves failed to detect an actionable relationship with different endometrial thicknesses and the relationship with an endometrial polyp, with most areas under the curve being just above 0.5. However, once the maximum stimulated endometrial thickness was ≥ 13mm, there was a 70% chance of a polyp being noted at hysteroscopy. This was a statistical difference in the probability of a polyp being present as compared to the lesser thicknesses (p = 0.05). Baseline or maximum stimulated endometrial thickness at IVF fails to predict with accuracy the presence of a polyp. However, if the maximum stimulated thickness was at least 13mm, there was a higher probability of a uterine polyp being present. Such a cutoff would nevertheless miss most polyps. At any baseline thickness on CD 2-5, a polyp has a 30-40% probability of being present in women who failed two embryo transfers. ROC curves suggest that at baseline, or maximum stimulated endometrial thickness, the ability to predict a polyp is no better than flipping a coin. As such, endometrial cavity evaluation for polyps is legitimate in women with two embryo transfers irrelevant of the baseline or stimulated thickness.

Multicentric Study on Endometrial Polyps and Endometriosis: Are They True or False Friends?

Many authors have reported an epidemiologic relationship between endometrial polyps and endometriosis. The joining link could be an unopposed and unbalanced estrogenic milieu. The prevalence of both, endometrial polyps and endometriosis, is quite high among general population. The presence of endometrial polyps and endometriosis could affect infertile women. We performed a retrospective multicentric study, based on data collected from three Hospitals (S. Antonio Abate, Trapani, Civico-Ascoli, Palermo, and Cannizzaro, Catania). We analyzed 285 women undergoing diagnostic/office hysteroscopy. Clinical history demographic and hysteroscopic data were collected in the same sheet, containing within informed consent. On the base of our results no relationship exists between endometrial polyps and endometriosis nor cervical polyps. It’s the first time that none correlation is proved for the coexistence of endometrial polyps and endometriosis. Further research is needed.

Higher Prevalence of Endometrial Polyps in Patients with Fallopian Tube Obstruction: A Case-control Study

To study the association between endometrial polyps and fallopian tube patency diagnosed by hysteroscopy, conventional histology, and 4-dimensional (4D) hysterosalpingo-contrast sonography (HyCoSy). A case-control study (Canadian Task Force classification II-2). A university hospital. A total of 323 women of reproductive age underwent 4D HyCoSy and hysteroscopy between January 2015 and December 2017. A retrospective analysis of the association of endometrial polyps and fallopian tube obstruction (n = 154) or patency (n = 169) in patients who underwent 4D HyCoSy. The prevalence of endometrial polyps was significantly higher in patients with bilateral fallopian tube obstruction than in patients with bilateral fallopian tube patency (42.9% [66/154] vs 20.1% [34/169], p <.0001). In univariate and multivariate analyses, the presence of endometrial polyps was found to be a risk factor for tubal obstruction with an odds ratio of 3.16 and 2.59, respectively. The prevalence of endometrial polyps is higher in infertile patients with fallopian tube obstruction than in patients with fallopian tube patency. History of endometrial polyps, ectopic pregnancy, and pelvic inflammatory disease are risk factors for tubal obstruction.

Analysis of Glycodelin Levels Before and After Hysteroscopic Polypectomy in Infertile Patients

Abstract Glycodelin (or placental protein 14) is a glycoprotein located in the glandular and thin epithelium of the endometrium. It is considered an important factor in the implantation process, and its traces can be found in elevated concentrations in the uterine flushing obtained at the time of implantation, while in the proliferative phase of the cycle, its levels are low. A certain concentration has been found to inhibit the binding of spermatozoids to the zona pellucida of the oocites therefore, it effects conception. It has a role in angiogenesis and is in high concentrations in the tissues of both benign and malignant gynaecological tumours. The aim of this study is to analyse and display the glycodelin level changes before and after hysteroscopic polypectomy in infertile patients in the uterine flushing fluid and serum. This survey covers 80 infertile patients, who were divided into two groups. The first group, the experimental group, consisted of 50 infertile patients with endometrial polyps, and a control group of 30 infertile patients without endometrial polyps was also included. The results primarily indicate the existence of changes in glycodelin levels preoperatively in the flushing and venous blood in infertile patients with endometrial polyps compared with the levels after surgery. In the control group of patients, no significant change in the glycodelin levels was detected in the flushing and venous blood. When comparing these two groups, statistically significant differences in the glycodelin levels in the flushing and venous blood were noted. We conclude that the presence of endometrial polyps in the cavum uteri affects the increase in the glycodelin concentration in the flushing fluid and in the plasma. Increased glycodelin concentrations complicate fertilization and implantation.

No evidence to support the concept that endometrial polyps impair fertility in the majority of cases

Purpose: To perform an updated literature search to determine whether hysteroscopic polypectomy helps to improve chance of pregnancy in infertile couples or reduce the risk of miscarriage. Materials and Methods: The authors conducted a personal review of the literature since 2009 (the last time such a search on the subject of polypectomy for infertility and miscarriage was performed by one of the authors). Results: No new studies were identified except a recent (2014) Cochrane Collaboration review from Polanski et al. was found. These authors had the same objective as we had in our previous publication in which an alleged randomized prospective trial (RCT) suggested that hysteroscopic polypectomy improved pregnancy rates following intrauterine insemination (IUI) vs. controls; however they included pregnancies obtained within three months after the procedure but before the four-month study period of IUI. Other flaws of the Perez-Medina study of 2005, that are even more significant, were pointed out by Polanski et al. Conclusions: Though no new studies shedding more insight whether the presence of endometrial polyps can impair fertility potential have been found, more flaws in design and conclusions of the one alleged RCT trail by Perez-Medina have been determined by a Cochrane review leading to the conclusion that there is not one properly designed and conducted RCT that supports hysteroscopic polypectomy to correct infertility in asymptomatic women. Though the possibility exists that irritating the endometrium by polypectomy can promote an inflammatory type endometrium, and thus improve embryo implantation and trophoblast invasion, other less invasive, less risky, less costly procedures can be performed, e.g., a single one swipe endometrial biopsy (now referred to as an endometrial scratch).

Endometrial Polyps: Which Patients Should Be Selected for Hysteroscopic Surgery?&amp;lt;br/&amp;gt;—A Study Using Data from the Swedish National Quality Registry of Gynecological Surgery

Objective: To illuminate the findings after hysteroscopic surgery of endometrial polyps. Method: Data were extracted from The Swedish National Quality Registry of Gynecological Surgery. Endometrial polyps were identified in 1934 cases in a total of 4512 hysteroscopic operations. Data on all hysteroscopic procedures registered as surgery of endometrial polyps between 1997 and January 2013 were analyzed with logistic regression analysis and effect size was calculated. Main outcome measure was malignancy in endometrial polyps. Results: The most frequently reported symptoms of endometrial polyps were: postmenopausal bleeding, metrorrhagia, pain, and infertility. Among the registered biopsies, there were: 30 malignancies (1.8%), and 41 dysplasias (2.5%). The remaining polyps were benign. Only 1/30 cancer patients were p p = 0.07). All cancer patients at age ≥52 had postmenopausal bleeding. The p = 0.014), controlling for age as a confounding factor. Conclusion: Hysteroscopic surgery should be recommended for women with postmenopausal bleeding and presence of endometrial polyps according to the findings of this study. The results further indicate a low risk of malignancy in premenopausal women <52 years with endometrial polyps. In those cases, it seems to be safe to refrain from surgery.

Role of Hysteroscopy Prior to Assisted Reproduction Techniques

Study ObjectiveTo determine whether diagnostic hysteroscopy before assisted reproduction techniques (ΑRT) in women without known disease of the uterine cavity is necessary. DesignProspective cohort clinical study. SettingReproductive medicine clinic. PatientsThe study group consisted of 217 infertile women attending the Reproductive Clinic for examination before undergoing ART, either in vitro fertilization or intracytoplasmic sperm injection. InterventionsPatients underwent transvaginal sonography (TVS) and hysterosalpingography (HSG) for initial evaluation. If there were no abnormal intrauterine findings, diagnostic hysteroscopy was additionally performed. Measurements and Main ResultsThe safety and diagnostic value of hysteroscopy before ART was examined. Diagnostic hysteroscopy was performed successfully, without complications, in all 217 women. Ninety-five (43.7%) had a history of ART failures (group 1), and 122 (56.3%) had undergone no previous ART attempts (group 2). In 148 women (68.2%), findings at hysteroscopy were normal, whereas in 69 (31.8%), hysteroscopy revealed intrauterine lesions (polyps, septa, submucosal leiomyomas, or synechiae) that led to operative hysteroscopy. The most common intrauterine abnormality was the presence of endometrial polyps in 26 patients (12%). The total percentage of abnormal intrauterine findings was higher in women with a history of repeated ART failures in comparison with those with no history of ART attempts. No statistically significant difference in the outcome of in vitro fertilization or intracytoplasmic sperm injection was observed between women with normal hysteroscopic findings and patients with hysteroscopically corrected endometrial disease. ConclusionSensitivity of diagnostic hysteroscopy is significantly higher than TVS and HSG in the diagnosis of intrauterine lesions. Diagnostic hysteroscopy should be performed before ART in all patients, including women with normal TVS and/or HSG findings, because a significant percentage of them have undiagnosed uterine disease that may impair the success of fertility treatment.

Risk Factors for Developing Endometrial Cancer After Benign Endometrial Sampling

To identify risk factors for endometrial cancer after benign results of endometrial biopsy or dilation and curettage (D&C). Nested case-control study from Rochester Epidemiology Project data. Among 370 Olmsted County, Minnesota, residents who received an endometrial cancer diagnosis between 1970 and 2008, we identified 90 patients (24.5%) who had previous benign endometrial biopsy or D&C results (no atypical hyperplasia). We compared them with 172 matched control group participants who had benign endometrial biopsy or D&C results without subsequent endometrial cancer. Using a multivariable conditional logistic regression model, we found that oral contraceptive pill (OCP) use was protective (odds ratio [OR] 0.18, 95% CI [CI] 0.08-0.45; P<.001), and personal history of colorectal cancer (OR 4.44, 95% CI 1.02-19.31; P<.05), endometrial polyp (OR 4.12, 95% CI 1.40-12.17; P=.01), and morbid obesity (OR 3.40, 95% CI 1.18-9.78; P<.03) were independently associated with subsequent endometrial cancer. Compared with the presence of no risk factor, presence of one and two or more risk factors increased the risk of endometrial cancer by 8.12 (95% CI 3.08-21.44) and 17.87 (95% CI 5.57-57.39) times, respectively. Assuming a 2.6% lifetime risk of endometrial cancer, ORs of 8.12 and 17.87 for one and two or more of the four aforementioned risk factors confer a lifetime risk of approximately 18% and 32%, respectively. One fourth of patients with endometrial cancer had previous benign endometrial biopsy or D&C results. Personal history of colorectal cancer, presence of endometrial polyps, and morbid obesity are the strongest risk factors for having endometrial cancer after a benign endometrial biopsy or D&C result, and OCP use is the strongest protective factor. II.

High prevalence of endometrial polyps in endometriosis-associated infertility

In a retrospective study, examination of 431 infertile women (158 cases with endometriosis and 273 without endometriosis) showed a significantly increased frequency of endometrial polyps in patients with endometriotic infertility and no significant differences among different stages and locations of endometriosis. Hysteroscopic polypectomy and removal of endometriotic foci significantly increased the chances of achieving a pregnancy compared with those without polyps.

Sessile polyps and pedunculated polyps respond differently to oral contraceptives

Endometrial polyp is the lesion frequently found by hysteroscopy. The presence of endometrial polyp is associated with abnormal uterine bleeding and is probably associated with infertility. Until today, clinical guidelines for endometrial polyp remain elusive. The aim of this preliminary study was to estimate whether the shape of endometrial polyps affects the response to the treatment with an oral contraceptive (OC). We performed a retrospective case series study on 50 women diagnosed as endometrial polyps by hysteroscopy and managed by the administration of OC. Hysteroscopy was performed in the follicular phase of the menstrual cycle before medical treatment. Endometrial polyps were classified as pedunculated polyps (n = 25) or sessile polyps (n = 25). After diagnosis, OC was administered for 2–5 months (median 3 months) intermittently: To quantify the regression rate of lesions, the area index of endometrial polyps was assessed. In the study group, when comparing the efficacy of treatment with OC, there was a statistically significant difference in the regression rate between sessile polyps and pedunculated polyps (76% vs. 44%, p = 0.042). We conclude that sessile polyps are more sensitive to OC treatment than pedunculated polyps, implying usefulness of the hysteroscopic classification of the shape of polyps in the management of endometrial polyps.

The effect of hysteroscopic polypectomy on the concentrations of endometrial implantation factors in uterine flushings

Endometrial polyps have been associated with infertility and early pregnancy loss. The aim of this study was to investigate the effect of hysteroscopic polypectomy on the concentrations of endometrial implantation factors in uterine flushings. Pre-menopausal women with a certain diagnosis of endometrial polyp on contrast-enhanced transvaginal ultrasound scan were recruited into this prospective study. In all women, paired samples of uterine flushings were obtained on the same day of the menstrual cycle prior to and post hysteroscopic polypectomy. Enzyme-linked immunoassays were performed to analyse glycodelin, interleukin-6 (IL-6), interleukin-10 (IL-10), tumour necrosis factor alpha (TNFalpha) and osteopontin, whilst immunoradiometric assay was used to analyse insulin-like growth factor binding protein-1 (IGFBP-1). Concentrations of IGFBP-1, TNFalpha and osteopontin in uterine flushings were significantly lower in the mid-secretory phase prior to polypectomy in comparison to the measurements obtained after complete surgical removal of the polyp (P < 0.05). There were no differences in the concentrations of glycodelin, IL-6 and IL-10 in paired samples prior to and post-polypectomy. The presence of endometrial polyps is associated with decreased mid-secretory concentrations of IGFBP-1, TNFalpha and osteopontin, which are reversed following surgical polypectomy.

Endometrium from women with endometriosis shows increased proliferation activity

Examination of 631 infertile women, including 434 women with endometriosis and 197 without endometriosis, revealed an increasing incidence of endometrial polyps, especially in the test subjects with endometriosis, and advanced stages of endometriosis. Expression of Ki-67 and Bcl-2 proteins and MTT assay results were significantly higher in endometrium of patients with endometriosis than in patients without endometriosis. These showed increased proliferation activity and cell proliferation markers not only clinically but also pathologically.

Are Diabetes, Hypertension, and Obesity Independent Risk Factors for Endometrial Polyps?

Study Objective To investigate whether diabetes, hypertension (HTN), and obesity can be considered risk factors for endometrial polyps (EPs) independently of age and menopausal status. Design Retrospective analysis (Canadian Task Force classification III). Setting Department of Obstetrics and Gynecology of the University of Foggia, Italy. Patients A total of 353 Caucasian women undergoing office hysteroscopy to assess abnormal uterine bleeding, infertility, cervical polyps, and abnormal sonographic patterns. Interventions Demographic characteristics and data on diabetes, HTN, and menopausal status were collected and anthropometric parameters were analyzed. Vaginoscopic hysteroscopy was performed with a 5-mm continuous-flow operative office hysteroscope. When present, EPs were treated during the same procedure by means of 5-Fr scissors or electrode. Measurements and Main Results In 134 (38%) of 353 cases, EPs were found. Univariable and multivariable analysis were performed to verify the presence of a statistically significant association among age, menopause, HTN, obesity, diabetes (independent variables), and the presence of EPs. Univariable logistic analysis showed a statistically significant association among age, menopause, HTN, obesity, and the presence of EPs. However, when multivariable logistic regression was performed, all the independent variables, except age, lost statistical significance (OR 1.05, 95% CI 1.02–1.07, p <.001). Conclusion Although it appears that EP is a disorder of aging, the significance of diabetes, HTN, and obesity, as well as menopause, on the development of EPs should be reconsidered.

Endometrial Microcalcifications Detected by Ultrasonography

Endometrial microcalcifications are uncommon, with alleged clinical implications ranging from innocuous to ominous. We reviewed the histopathologic slides from 29 patients who had endometrial echogenic foci on pelvic ultrasound and found many endometrial microcalcifications. The extent of microcalcifications in each specimen was graded on a semiquantitative scale from 0 to 3. The mean patient age was 54 years (range, 34-81 years). The specimens included endometrial biopsies, curettages, and hysterectomies. Most of the patients had presented with abnormal vaginal bleeding. Fifteen patients (51.7%) were postmenopausal, 10 (34.5%) were premenopausal, and the rest were perimenopausal. The most frequent endometrial types were atrophic (39.5%), inactive (23.3%), and proliferative (14%). Six specimens (14%) showed benign endometrial polyps. One patient had well-differentiated endometrioid carcinoma of the endometrium without myometrial invasion. Specimens from 16 patients (55.2%) had microcalcifications. The patients with calcifications were older than those without calcifications (mean age, 60 vs. 47 years, respectively; P = 0.017). The extent of microcalcifications positively correlated with the presence of endometrial polyps (P = 0.00076), postmenopausal state (P = 0.004), atrophic endometrium (P = 0.002), and hormone replacement therapy (P = 0.013). The microcalcifications were concentric or amorphous, intraglandular or stromal. They were focally associated with minute papillary epithelial projections or with degenerated endometrial glands. Follow-up was available on 26 patients (89.7%). Except for the patient with endometrioid carcinoma, none has developed uterine, adnexal, or peritoneal malignancy. In summary, endometrial microcalcifications are histologically heterogeneous and are associated with older patient age, postmenopausal state, atrophic endometrium, and endometrial polyps. Those found incidentally by means of pelvic ultrasonography, in our experience, did not portend malignancy.

Clinical effectiveness of hysteroscopy in abnormal uterine bleeding

The introduction of intrauterine endoscopy has allowed clinicians to evaluate an area of the body that was previously accessible only by the procedure of blind dilation and curettage (D&C). Many studies have shown hysteroscopy to be superior to D&C, yet its use has yet to be appreciated adequately. The use of hysteroscopy has been most common in the evaluation of abnormal uterine bleeding. This study showed that the most common indication for hysteroscopy was abnormal uterine bleeding (98%). Hysteroscopy was performed successfully in 91% of cases and a complete view of the uterine cavity was obtained. Intrauterine pathology was diagnosed in 60%, the highest incidence being found in those between 40 and 60 years old (80%). The presence of endometrial polyps was the most common abnormality (27·3%; n =105), and increased with age to 20% in women over 60 years. Conversely the incidence of fibroids decreased with age; only 5% in women older than 60 years. Endometrial biopsy was performed in all patients and produced adequate tissue for histological examination in 50%. Endometrial hyperplasia and carcinoma was detected in 9·9%. Sixty-three women underwent a minor hysteroscopic procedure.