Comparison of Endorette® and dilatation and curettage for sampling of the endometrium in women with postmenopausal bleeding

Abstract

Main question. To compare the diagnostic properties of Endorette® and D&C in women with postmenopausal bleeding, to relate the properties to endometrial thickness as measured by ultrasound, and to assess the women's experiences of the two methods. Methods. In a prospective study, 133 consecutive women with postmenopausal bleeding were examined with transvaginal ultrasound. After measuring the endometrial thickness, Endorette® sampling was performed without anesthesia. Dilatation and curettage (D&C) was carried out under general anesthesia within six weeks. After completion of each sampling procedure the women filled in a questionnaire regarding their experience of the sampling. Results. Endorette® sampling failed in 16% (21/133) of the women. More than half (56%) of the women experienced moderate or strong pain during Endorette® sampling, and the doctor underestimated the pain in 62% of the women. Endorette® failed to diagnose two of seven (29%) endometrial cancers found at D&C. In one of these two cases, the examiner suspected that the Endorette® device had not reached the uterine fundus. In women with endometrium <7 mm, Endorette® and D&C showed similar results with regard to obtaining a sufficient endometrial sample and to distinguishing normal endometrium, benign pathological endometrium and malignancy. In women with endometrium ≥7 mm, Endorette® yielded insufficient samples significantly more often than D&C (23% vs 6%, p=0.02; the McNemar test) and missed all polyps and most (77%) hyperplasias diagnosed by D&C. Conclusion. Endorette® and D&C have similar diagnostic properties in women with postmenopausal bleeding and endometrium <7 mm. D&C is superior to Endorette® in women with endometrium ≥7 mm.