Page 41 - The diagnostic work-up of women with postmenopausal bleeding

We can conclude that the first step in the diagnostic pathway should be the measurement of endometrial thickness, using a cut-off point of 3 or 4 mm, followed
by endometrial sampling. Figure 3 shows an algorithm with an evidence-based
diagnostic pathway for women with PMB. Only when TVS is not readily available 2 should direct endometrial sampling be an option. For further investigation when
the sample is insufficient or when it is unsuccessful, SIS can be used to distinguish between focal and diffuse pathology. Hysteroscopy should be used as the final step in the diagnostic pathway of women with PMB.
Conclusions
• Neither in systematic reviews nor in international guidelines is consensus found regarding the best sequence of diagnostic procedures for women with PMB.
• Measurement of endometrial thickness, endometrial sampling and hysteroscopy have been independently shown to be accurate in excluding endometrial cancer.
• In relation to endometrial thickness,a cut-off value of 3 or 4 mm is recommended, but the cost-effectiveness of this strategy has yet to be demonstrated.
Diagnostic evaluation
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