Follow-up of women after a first episode of postmenopausal bleeding and endometrial thickness greater than 4 millimeters

Anne Timmermans, Lena C. Van Doorn, Brent C. Opmeer, Maurice V.A.M. Kroeks, M. Jitze Duk, Annette M. Bouwmeester, Roy F.M.P. Kruitwagen, F. Paul H.L.J. Dijkhuizen, Ben W.J. Mol

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OBJECTIVE: To estimate the incidence of recurrent postmenopausal bleeding among women who were diagnosed with an endometrial thickness greater than 4 mm. METHODS: We designed a prospective cohort study and included consecutive women not using hormone replacement therapy, presenting with a first episode of postmenopausal bleeding. We evaluated patients who had an endometrial thickness greater than 4 mm at transvaginal ultrasonography and benign endometrial sampling; presence of carcinoma was ruled out by office endometrial sampling, hysteroscopy, and/or dilation and curettage. Time until recurrent bleeding was measured, and diagnosis at recurrent bleeding was recorded. RESULTS: Among 318 patients who had an endometrial thickness greater than 4 mm, 222 patients had benign histology results and were available for follow-up. During follow-up, 47 (21%, 95% confidence interval 16-27%) patients had recurrent bleeding, with a median time to recurrent bleeding of 49 weeks (interquartile range 18 to 86 weeks). There was no difference with respect to recurrence rate between patients with polyp removal, patients with a normal hysteroscopy, and patients with office endometrial sampling alone at the initial workup. Two patients were diagnosed with atypical endometrial hyperplasia upon recurrent bleeding. CONCLUSION: The recurrence rate of postmenopausal bleeding in women with endometrial thickness greater than 4 mm is 20%. This recurrence rate is not related to incorporation of hysteroscopy or polyp removal at the initial workup.

Original languageEnglish
Pages (from-to)137-143
Number of pages7
JournalObstetrics & Gynecology
Issue number1
Publication statusPublished - 1 Jan 2008
Externally publishedYes

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