An unnecessary ouch: is routine outpatient endometrial sampling indicated where hysteroscopy reveals an atrophic cavity?

Abstract

There is currently little guidance in the literature as to whether routine endometrial sampling is indicated after a normal or atrophic cavity has been visualised at outpatient hysteroscopy for post-menopausal bleeding. Retrospective electronic database review of women with post-menopausal bleeding attending an outpatient hysteroscopy clinic was performed. Seventy-nine patients underwent outpatient hysteroscopy for post-menopausal bleeding. Forty-four of these (56 %) were found to have normal or atrophic cavities with no other visible pathologies. Forty of these women (89 %) underwent endometrial sampling. Thirty of those sampled (75 %) had an interpretable sample showing a normal or atrophic endometrium on histology, and ten were reported as inadequate for analysis. There were no reports of abnormal histology in this cohort. Routine endometrial sampling at outpatient hysteroscopy where the cavity has been visualised as normal or atrophic did not reveal any unexpected pathology. It may be possible to omit this painful procedure, but further larger studies are required.