Survey on Selection Criteria Indication for Patients with Postmenopausal Bleeding for Hysteroscopy: Variation in Current Practice and Implications for Clinical Effectiveness

Abstract

Abstract

Objectives:

This survey was conducted to examine variations in practice for selecting women with postmenopausal bleeding (PMB) in the United Kingdom for hysteroscopy and endometrial biopsy. A secondary objective was to drive future research to improve clinical effectiveness.

Materials and Methods:

An online anonymous questionnaire was sent to British Society for Gynaecological Endoscopy and British Gynaecological Cancer Society members regarding their current practices for selecting women with PMB for hysteroscopy and endometrial biopsy. A reminder was sent to nonresponders prior to the end of the study. Quantitative and qualitative analysis were performed.

Results:

Three hundred society members responded. The minimum endometrial thickness (ET) necessitating an endometrial biopsy varied among respondents from 3 mm to 5 mm. Twenty-five respondents, however, said that endometrial biopsy was always performed regardless of ET. Of the 53% of respondents who had a cutoff ET to indicate a need for hysteroscopy, there was significant disparity, with cutoffs varying between 3 and 12 mm. A significant majority of respondents suggested implementing an accreditation process for scanning and hysteroscopy in patients with PMB to improve clinical effectiveness.

Conclusions:

There is wide variation in patient selection protocols for hysteroscopy and endometrial biopsy after an initial assessment of the endometrium by ultrasound (US). There is an urgent need for further study to clarify which patients require diagnostic hysteroscopy and/or endometrial biopsy in addition to US as a part of the investigation for PMB. This research, however, should preferably be conducted only after nationally defined standards for gynecology scanning are accepted. (J GYNECOL SURG 34:197)