Diagnostic and therapeutic advantages of hysteroscopic surgery in management of intrauterine lesions in postmenopausal women.

STUDY

OBJECTIVE

To determine the value of hysteroscopic surgery in the management of intrauterine lesions in postmenopausal women.

DESIGN

Descriptive study (Canadian Task Force classification II-2).

SETTING

Tertiary care university hospital. Patients. Fifty postmenopausal women, most with vaginal bleeding, all with intrauterine lesions (leiomyomas, polyps, adhesions) on hysteroscopy or ultrasound.

INTERVENTION: Hysteroscopic operations consisting of myomectomy, polypectomy, and adhesiolysis.

MEASUREMENTS AND MAIN

RESULTS

Forty-seven procedures were completed successfully by hysteroscopy; partial myomectomies were performed in three women for large or deeply embedded leiomyomas. The only complication was one case of fluid overload. Median operating time was 20.0 minutes (range 5.0-60.0 min) and median postoperative hospital stay was zero days (range 0-2 days). Eight patients (16%) subsequently underwent hysterectomy, mostly for uterine malignancy or premalignancy. In two cases, the operative specimen included malignant elements that were not evident on preoperative endometrial biopsy. During mean follow-up of 33.1 months (range 6-72 mo), 95.2% of women without hysterectomy were free of symptoms.

CONCLUSION

Hysteroscopic surgery is an effective and safe option for postmenopausal women with intrauterine lesions. It allows the correct diagnosis to be made, reduces the need for major and unnecessary surgery, and is therapeutic in most patients. (J Am Assoc Gynecol Laparosc 8(1):87-91, 2001)