Role of hysteroscopy in management of abnormal uterine bleeding in perimenopausal women

Background: In perimenopausal women blind endometrial sampling, dilation and curettage (D and C) was the standard treatment. Since hysteroscopy offers complete visualization of entire endometrial cavity. This prospective study was undertaken to evaluate its role. As whole of endometrial cavity examined and target biopsy can be taken from suspected area so that no carcinoma is missed.  Thus, study was conducted to evaluate role of hysteroscopy in abnormal uterine bleeding (AUB) in women of perimenopausal age group and to correlate the hysteroscopic findings with that of histopathology and to see complication of hysteroscopy, if any. Methods: The study was carried out in the department of obstetrics and gynecology at Kasturba hospital, Delhi, India. 162 patients of age group 40-55 years with AUB were included. Any demonstrable pelvic pathology like cancer of cervix, vagina or endometrium and active pelvic inflammatory disease (PID) was set as exclusion criteria. All patients were subjected to hysteroscopy followed by D and C and findings of hysteroscopy and histopathology was correlated. Results: On hysteroscopy endometrium was normal in 49.3%, hyperplastic in 24.6%, atrophic in 10.4% and suspected carcinoma endometrium in 3.08%. Endometrial polyp and submucous fibroid was seen in 4.9% cases and 7.4% cases each. On confirmation by histopathology the findings were: normal endometrium in 55.4% cases, hyperplastic in 20.3%, atrophic in 9.9% and carcinoma endometrium in 1.85%. All cases of submucous fibroid and polyp were confirmed on histopathology. Conclusions: Hysteroscopy increases the accuracy of clinical diagnosis and may serve as an adjunct in the treatment of patients with specific intrauterine pathological conditions causing AUB.