Clinical pathway for evaluating women with abnormal uterine bleeding.

Abstract

OBJECTIVE To devise a clinical pathway for evaluating women with abnormal uterine bleeding. STUDY DESIGN One thousand women with the complaint of abnormal uterine bleeding were enrolled. All would have undergone endometrial biopsy based on older recommendations. The patients followed a clinical pathway to determine if an endometrial biopsy was necessary. The pathway divided women into the categories of premenopausal, postmenopausal, low risk and high risk. If one risk factor was present, the patient underwent endometrial biopsy. If there were no risk factors, the patient continued down the pathway with medical therapy. RESULTS Five hundred seventy endometrial biopsies were performed. Five cases of endometrial cancer and three of complex atypical hyperplasia, both in the postmenopausal, high-risk group, were discovered. Subsequent reviews revealed that no cases of endometrial cancer were missed or developed in the two years following the initial complaint. CONCLUSION Utilization of a clinical pathway reduced the number of endometrial biopsies by 50%. The introduction of clinical pathways at our institution was done successfully in the evaluation of abnormal uterine bleeding.