[Gynaecological diagnosis of postmenopausal women with abnormal vaginal bleeding: a comparison with the guideline].

OBJECTIVE

The Dutch guideline for obstetrics and gynaecology recommends transvaginal echography for all patients with postmenopausal vaginal bleeding, followed by histological examination in case the double endometrium layer is either > 4 mm or cannot be measured. We assessed whether this guideline was applied in clinical practice.

DESIGN

Prospective.

METHOD: Data were collected on the diagnosis of 837 patients with post-menopausal vaginal bleeding who were seen in the gynaecology clinics of eight hospitals during the period 1 January 2001-31 December 2002. Subsequently, the actual practice was compared with the guideline, which was known in all the hospitals at the start of the study.

RESULTS

Transvaginal echography was performed in 818 of 837 (98%) women. The thickness of the endometrium could not be measured in 74 (9%) patients, was < or = 4 mm in 361 (43%) women and > 4 mm in 383 (46%) women. In 56 (7%) patients, including 3 who refused further diagnostics, a histological diagnosis was not obtained even though it should have been according to the guideline. A histological diagnosis was obtained in 118 (13%) patients in whom this was not necessary according to the guideline. In 86 (10%) patients, a hysteroscopy and/or curettage was performed, even though a histological diagnosis by endometrial aspiration might have sufficed.

CONCLUSION

Adherence to the guideline on the diagnostic management of postmenopausal bleeding was fairly good. Overdiagnosis was seen more frequently than underdiagnosis. The efficiency of the diagnostic management in women with postmenopausal bleeding might be increased by limiting histological examination to women with an increased endometrial thickness, and by relying on endometrium aspiration in these women.