Page 26 - The diagnostic work-up of women with postmenopausal bleeding

Chapter 2
Abstract
Postmenopausal bleeding (PMB) is a common complaint in general gynaecological practice.Women with PMB have around a 10% chance of having endometrial cancer and therefore PMB always needs further evaluation.This article summarises the reviews on the subject and provides an overview of the use of diagnostic tools in patients with PMB. Four types of diagnostic test are described: sonographic measurement of endometrial thickness, endometrial sampling, hysteroscopy and saline infusion sonography. All four have been independently shown to be accurate in excluding endometrial cancer. However, neither in systematic reviews nor in international guidelines is consensus found regarding the sequence in which these methods should be employed in women with PMB. For measurement of endometrial thickness in symptomatic women, a cut-off value of three millimetres is recommended, but the cost-effectiveness of this strategy has yet to be shown. Research should now focus on the incorporation of individual patient characteristics and pre-test probabilities for cancer in algorithms for the investigation of PMB, and the most cost-effective sequenced combination of the four types of tests.
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