A Deeper Look at Office Hysteroscopy in Asymptomatic Postmenopausal Patients: Indications and Outcomes of 822 Cases

Study Objective

This study aims to assess the prevalence of malignancy and other endometrial pathologies in asymptomatic postmenopausal women referred for office hysteroscopy (OH), identify main referral indications, and assess their relationship with the risk of malignancy. Secondary objectives included evaluating the association between ultrasound variables and malignancy risk and assessing procedure validity, which encompasses duration, feasibility, and patient comfort during OH.

Design

Retrospective analysis.

Setting

The study was conducted at the Department of Gynecology, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Slovenia's largest tertiary care center.

Participants

The cohort consisted of 822 asymptomatic postmenopausal women referred for OH, excluding those with postmenopausal bleeding within the last year.

Interventions

Participants underwent OH with or without biopsy.

Measurements and Main Results

The main indication for hysteroscopy was ultrasound abnormalities alone, with remaining indications including a combination of ultrasound and clinical findings. Among the cohort, 97.4% exhibited benign findings, while 2.6% were diagnosed with cancer or precancerous lesions. The analysis revealed that patients with indications based on ultrasound and clinical findings suggestive of malignancy had a higher risk of malignancy compared to those with ultrasound alone. In 387 patients with documented ultrasound variables, inhomogeneous endometrial appearance (OR: 8.2, 95% CI: 2.4–27.9, p < .001) and significant liquid content within the uterine cavity (OR: 10.2, 95% CI: 3.6–28.9, p < .001) exhibited strong associations with malignancy. Analysis of the procedure revealed a high feasibility rate (87.8%), with a median duration of 13.7 minutes and a median Visual Analog Scale pain score after the procedure of 3/10.

Conclusion

The prevalence of endometrial cancer and precancerous lesions in asymptomatic postmenopausal patients is likely low, with most intrauterine pathologies being benign. Our study demises the utility of routine endometrial surveillance for this population in the absence of specific risk factors. A holistic approach, considering individualized assessments and factors beyond endometrial thickness, is crucial in interpreting ultrasonic findings.