Office hysteroscopy in patients with abnormal uterine bleeding and normal transvaginal sonography

Abstract

Background: Abnormal uterine bleeding (AUB) is one of the most common clinical problems in gynecology. Transvaginal sonography (TVS) and hysteroscopy are two diagnostic methods for patients with AUB. For most of the patients with AUB, diagnostic hysteroscopy can be done in clinic with minimal discomfort and much lower expense than operative room. Materials and Methods: In our clinical trial study, from March 21, 2005 to March 20, 2007, patients with AUB in Ahwaz Imam Khomayni hospital, after history and physical examinations underwent TVS. Of those, 147 patients with normal TVS entered the study and were considered for outpatient hysteroscopy. Patients with endometrial cavity lesion were scheduled for operation room, and those with empty endometrial cavity aspiration biopsy were done outpatiently. Specimens were sent to pathologist for examination. Results: All the patients were divided into three groups: group 1 or minority was under 30 years old (7 women), group 2 was 30-40 years, and group 3 or majority was over 40 years old (96 women). 115 patients (78.2%) had normal and 32 patients (21.8%) had abnormal hysteroscopic results. 116 patients (78.8%) had normal and 31 patients (21.2%) had abnormal pathologic results; moreover, cervical canal polyp was the most common lesion hysteroscopically and pathologically in all groups. Conclusion: Of 147 patients (100%) with AUB and normal TVS, 32 patients (21.8%) were abnormal hysteroscopically. Cervical canal polyps may be missed by transvaginal sonography, but can be diagnosed by hysteroscopy. In patients with AUB and normal TVS, hysteroscopy can be used as the second step.