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Wei L, Zhao Y, Xu S, Zhang C. Association Between Endometritis and Endometrial Polyp: A Mendelian Randomization Study. Int J Womens Health 2023; 15:1963-1970. [PMID: 38144947 PMCID: PMC10749105 DOI: 10.2147/ijwh.s434299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/13/2023] [Indexed: 12/26/2023] Open
Abstract
Background Endometrial polyps (EPs) are one of the most common intrauterine benign tumors, and are an important cause of uterine bleeding and female infertility. Previous studies have suggested that endometritis may contribute to the onset of EPs. This study aims to reveal the causal effect of endometritis on EPs by a two-sample Mendelian randomization (MR) study. Methods Utilizing summarized statistics from genome-wide association studies (GWAS) in the European population, we conducted a Mendelian randomization study. In order to select suitable instrumental variables (IVs) that were significantly related to the exposures, a number of quality control approaches were used. For endometritis, 2144 cases and 111,858 controls were included, while for EPs, 2252 cases and 460,758 controls. Utilizing the inverse variance weighted (IVW) as the primary analysis, the data were subjected to a two-sample MR analysis, and the weighted median (WM) technique and MR-Egger regression were carried out additionally. The sensitivity analysis revealed neither heterogeneity nor horizontal pleiotropy. Results Four independent single nucleotide polymorphisms (SNPs) from endometritis GWAS as IVs were selected. The IVW data did not agree to a causal association between endometritis and EPs (β=1.11e-04, standard error [SE] =4.88e-04, P = 0.82). Directional pleiotropy did not affect the outcome, according to the MR-Egger regression (intercept = 0.09, P = 0.10); Additionally, it showed no causation association between endometritis and EPs (β= -3.28e-03, SE = 3.54e-03, P = 0.45). Similar results were obtained using the weighted-median method (β=8.56e-05, SE=5.97e-04, P = 0.89). No proof of heterogeneity and horizontal pleiotropy between IV estimates was discovered. Conclusion In conclusion, by large scale genetic data, the results of this MR analysis provided suggestive evidence that the presence of endometritis is not associated with higher EPs risk.
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Affiliation(s)
- Longlong Wei
- Department of Reproductive Medicine Center, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
- Department of Reproductive Medicine Center, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China
| | - Yan Zhao
- Department of Reproductive Medicine Center, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China
| | - Siyue Xu
- Department of Reproductive Medicine Center, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China
| | - Cuilian Zhang
- Department of Reproductive Medicine Center, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
- Department of Reproductive Medicine Center, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China
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2
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Ren H, Zhang Y, Duan H. Recent advances in the management of postmenopausal women with non-atypical endometrial hyperplasia. Climacteric 2023; 26:411-418. [PMID: 37577792 DOI: 10.1080/13697137.2023.2226316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 04/30/2023] [Accepted: 06/08/2023] [Indexed: 08/15/2023]
Abstract
Non-atypical endometrial hyperplasia is a benign disease without significant somatic genetic changes. Postmenopausal women with non-atypical endometrial hyperplasia have a significant risk of progression to endometrial cancer and persistent endometrial hyperplasia. Most cases of atypical endometrial hyperplasia in postmenopausal women are treated surgically, including hysterectomy. At present, the treatment of postmenopausal women with non-atypical endometrial hyperplasia is still controversial. Correct and timely diagnosis and treatment are of great significance to prevent progression of the lesion. This study mainly provides an updated synthesis of the literature that investigates the etiology, diagnosis and treatment of postmenopausal women with non-atypical endometrial hyperplasia. As of December 2022, a literature search related to postmenopausal non-atypical endometrial hyperplasia was conducted on the PubMed database. For most postmenopausal patients with non-atypical endometrial hyperplasia, regular re-examination should be performed during conservative treatment. For postmenopausal patients with endometrial cancer risk factors, persistent non-atypical endometrial hyperplasia or progesterone contraindications, hysterectomy and bilateral salpingo-oophorectomy should be the first choice.
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Affiliation(s)
- H Ren
- Department of Minimally Invasive Gynecologic Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Y Zhang
- Department of Minimally Invasive Gynecologic Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - H Duan
- Department of Minimally Invasive Gynecologic Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
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3
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Black D. Diagnosis and medical management of abnormal premenopausal and postmenopausal bleeding. Climacteric 2023; 26:222-228. [PMID: 36847215 DOI: 10.1080/13697137.2023.2178893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Abnormal uterine bleeding is a common reason for presentation to health-care providers: it is estimated that one woman in three will present to a care provider with abnormal uterine bleeding (AUB) during the reproductive years, and that at least one woman in 10 will experience postmenopausal bleeding. Although there are some variations in national guidelines for investigation, diagnosis and management of premenopausal AUB, there are far more areas of agreement than disagreement. A comprehensive literature search was undertaken to review national and international guidelines regarding investigation, diagnosis and management of AUB in both premenopausal and postmenopausal women. Areas of controversy are identified, and latest evidence reviewed. Although efforts to reduce hysterectomies for premenopausal AUB through medical management have largely been successful, there are areas where more research is necessary to guide optimal investigation and management. Many countries have well-defined guidelines for investigation and management of premenopausal AUB: there are fewer well-developed guidelines for investigation and management of postmenopausal bleeding. There is a paucity of evidence-based data on management of unscheduled bleeding on menopausal hormone therapy.
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Affiliation(s)
- D Black
- Department of Obstetrics, Gynecology and Reproductive Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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4
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Cantalogo LR, Jammal MP, Gomes MKO, Murta EFC, Nomelini RS. Management of ultrasonographic endometrial thickness in postmenopausal asymptomatic women. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2022; 68:417-421. [PMID: 35442374 DOI: 10.1590/1806-9282.20210929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 12/24/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Letícia Rodrigues Cantalogo
- Universidade Federal do Triângulo Mineiro, Research Institute of Oncology, Department of Gynecology and Obstetrics - Uberaba (MG), Brazil
| | - Millena Prata Jammal
- Universidade Federal do Triângulo Mineiro, Research Institute of Oncology, Department of Gynecology and Obstetrics - Uberaba (MG), Brazil
| | - Mariana Kefalás Oliveira Gomes
- Universidade Federal do Triângulo Mineiro, Research Institute of Oncology, Department of Gynecology and Obstetrics - Uberaba (MG), Brazil
| | - Eddie Fernando Candido Murta
- Universidade Federal do Triângulo Mineiro, Research Institute of Oncology, Department of Gynecology and Obstetrics - Uberaba (MG), Brazil
| | - Rosekeila Simões Nomelini
- Universidade Federal do Triângulo Mineiro, Research Institute of Oncology, Department of Gynecology and Obstetrics - Uberaba (MG), Brazil
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5
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Endometrial hyperplasia in pre-menopausal women: a systematic review of incidence, prevalence, and risk factors. Eur J Obstet Gynecol Reprod Biol 2022; 271:158-171. [DOI: 10.1016/j.ejogrb.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/04/2022] [Accepted: 02/13/2022] [Indexed: 11/18/2022]
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De Franciscis P, Riemma G, Schiattarella A, Cobellis L, Guadagno M, Vitale SG, Mosca L, Cianci A, Colacurci N. Concordance between the Hysteroscopic Diagnosis of Endometrial Hyperplasia and Histopathological Examination. Diagnostics (Basel) 2019; 9:diagnostics9040142. [PMID: 31591361 PMCID: PMC6963519 DOI: 10.3390/diagnostics9040142] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 12/19/2022] Open
Abstract
The goal of this paper is to assess the concordance between the clinical diagnosis of Endometrial Hyperplasia (EH), suspected by senior gynecologists throughout outpatient office hysteroscopy, and the results from histopathological examination, in order to evaluate hysteroscopic accuracy for EH. A prospective cohort study was done at a Tertiary University Hospital. From January to December 2018, we enrolled women with the following criteria: abnormal uterine bleeding in post-menopause and endometrial thickening in pre-or post-menopause. Patients underwent office hysteroscopy with a 5 mm continuous-flow hysteroscope, and endometrial biopsies were taken using miniaturized instruments. Senior operators had to foresee histopathological diagnosis using a questionnaire. Histopathological examination was conducted to confirm the diagnosis. This study was approved by the local ethical and registered in the ClinicalTrials.gov registry (ID no. NCT03917147). In 424 cases, 283 clinical diagnoses of EH were determined by senior surgeons. A histopathological diagnosis was then confirmed in 165 cases (58.3%; p = 0.0001). Furthermore, 14 endometrial carcinoma and atypical hyperplasia were found. The sensitivity, positive predictive value, and negative predictive values for EH were, respectively, 90.4, 58.4, and 86.6%. Subdivided by clinical indication, the sensitivity was higher in patients with post-menopause endometrial thickening. The diagnostic accuracy of office hysteroscopy in the diagnosis and prediction of endometrial hyperplasia was high. Senior operators could foresee EHs in more than half the cases.
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Affiliation(s)
- Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
| | - Antonio Schiattarella
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
| | - Luigi Cobellis
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
| | - Maria Guadagno
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
| | - Salvatore Giovanni Vitale
- Unit of Obstetrics & Gynecology, Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy.
| | - Lavinia Mosca
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
| | - Antonio Cianci
- Unit of Obstetrics & Gynecology, Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy.
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
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7
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New idea for hair transplantation to preserve more donor hair follicles. Med Hypotheses 2019; 128:83-85. [PMID: 31203916 DOI: 10.1016/j.mehy.2019.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 05/12/2019] [Indexed: 11/23/2022]
Abstract
Higher risk of rapid progression in alopecia or male pattern baldness was observed in men who had family history. This could result from accumulation of DHT in hair follicles. Hair follicles on frontal region are more vulnerable to DHT. With development of minimal invasive hair transplantation surgery, hair follicles transplantation could be performed from frontal or occipital region to frontal region. However, limited hair follicles remained a problem. With development of technology of vitrification, we suggested extracting hair follicles from frontal region without affecting the appearance and preserving them with vitrification when the patient was young. When alopecia progressively developed, these extracted hair follicles would increase the donor number of hair follicles used for transplantation, which could extend longer dense hair appearance.
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Chronic Endometritis, a Common Disease Hidden Behind Endometrial Polyps in Premenopausal Women: First Evidence From a Case-Control Study. J Minim Invasive Gynecol 2019; 26:1346-1350. [PMID: 30708117 DOI: 10.1016/j.jmig.2019.01.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/10/2019] [Accepted: 01/20/2019] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE To investigate the correlation between endometrial polyps (EPs) and chronic endometritis (CE). DESIGN Single-center retrospective case-control study. SETTING Academic center. PATIENTS A total of 480 premenopausal women with abnormal uterine bleeding (AUB) were enrolled. Group A included 240 women suffering from EPs (diagnosed by hysteroscopy and histology), and group B included 240 patients without EPs at hysteroscopy. INTERVENTIONS In group A, 2 separate samples were obtained from the EPs (group A polyps) and endometrium (group A endometrium). In group B, a single sample of endometrial tissue was evaluated (group B endometrium). All tissue samples were subjected to immunohistochemistry for CD-138 for plasma cell identification. MEASUREMENTS AND MAIN RESULTS The primary study endpoint was to compare the rates of CE in group A endometrium versus group B endometrium. The secondary endpoint was to evaluate the consistency in CD-138 immunoreactivity between group A polyps and compared with group A endometrium. A higher prevalence of CE was observed in group A endometrium compared with group B endometrium (p < .0001). The total percentage of EPs showing CD-138 positivity was 76.7% (184 of 240). CE was more frequent in women with CD-138+ EPs compared to those with CD-138- EPs (p < .0001). CONCLUSIONS EPs were commonly associated with CE in the premenopausal women suffering from AUB. Moreover, the majority of EPs were positive for CD-138 staining, suggesting a possible hidden association between chronic inflammation and EPs.
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Trojano G, Damiani GR, Casavola VC, Loiacono R, Malvasi A, Pellegrino A, Siciliano V, Cicinelli E, Salerno MG, Battini L. The Role of Hysteroscopy in Evaluating Postmenopausal Asymptomatic Women with Thickened Endometrium. Gynecol Minim Invasive Ther 2018; 7:6-9. [PMID: 30254927 PMCID: PMC6135156 DOI: 10.4103/gmit.gmit_10_17] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Backgrounds and Aims: This study aims to compare hysteroscopic and histological findings in asymptomatic postmenopausal patients with thickened endometrium. Materials and Methods: A retrospective study involving case records of 295 asymptomatic postmenopausal women with a thickened endometrium >5 mm diagnosed at transvaginal ultrasound (TVS). Patients (women) underwent hysteroscopy with biopsy between 2009 and 2015, and they were followed up at National Cancer Institute of Bari and at University Hospital of Pisa. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of hysteroscopy were evaluated. Results: Inclusion criteria were TVS, hysteroscopy, and endometrial biopsy. When the hysteroscopic findings were normal, a sensitivity of 100%, specificity of 98.6%, PPV of 95.2%, and NPV of 100% were achieved. For polyps and myomas, we found 100%, 98.7%, 99.5%, and 100%, respectively. In case of endometrial hyperplasia, a sensitivity of 66.7%, a specificity of 100%, a PPV of 100%, and a NPV of 98.1% were achieved. For endometrial cancer hysteroscopy, sensitivity, specificity, PPV, and NPV were 100%, 99.6%, 75%, and 100%, respectively. Conclusions: Hysteroscopy allows an accurate diagnosis in benign endometrial pathology and suspect of malignant endometrial pathology in postmenopausal women with thickened endometrium.
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Affiliation(s)
- Giuseppe Trojano
- Department of Obstetrics and Gynaecology, University of Bari, Lecco, Italy
| | | | | | - Rossella Loiacono
- National Cancer Research Centre, Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Antonio Malvasi
- Department of Obstetrics and Gynaecology, Santa Maria Hospital, Bari, Italy
| | - Antonio Pellegrino
- Department of Obstetrics and Gynaecology, AOUP Santa Chiara Hospital, Pisa, Italy
| | - Valeria Siciliano
- Institute of Clinical Phisiology, National Research Council of Italy, Rome, Italy
| | - Ettore Cicinelli
- Department of Obstetrics and Gynaecology, University of Bari, Lecco, Italy
| | | | - Lorella Battini
- Department of Obstetrics and Gynaecology, AOUP Santa Chiara Hospital, Pisa, Italy
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Abstract
Endometrial evaluation is generally indicated in cases presenting with abnormal uterine bleeding (AUB), especially in women more than 35 years of age. AUB encompasses a variety of presentation, for example, heavy menstrual bleeding, frequent bleeding, irregular vaginal bleeding, postcoital and postmenopausal bleeding to name a few. Many methods are used for the evaluation of such cases, with most common being sonography and endometrial biopsy with very few cases requiring more invasive approach like hysteroscopy. Endometrial aspiration is a simple and safe office procedure used for this purpose.
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Affiliation(s)
- Pratibha Singh
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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11
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Garg G, Patvekar M, Agarwal K, Bhatia I, Sanghi S. A Study of the Role of Hysteroscopy in Abnormal Uterine Bleeding. J Gynecol Surg 2017. [DOI: 10.1089/gyn.2017.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gazal Garg
- Department of Obstetrics and Gynecology, DDU Hospital, Delhi, India
| | - Meena Patvekar
- Department of Obstetrics and Gynecology, Dr. D.Y. Patil Medical College Hospital & Research Centre, Pimpri, Pune, India
| | - Kriti Agarwal
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Sciences (PIGIMS), Rohtak, Haryana, India
| | - Ishan Bhatia
- Department of Anaesthesia, DDU Hospital, Delhi, India
| | - Sahil Sanghi
- Department of Orthopaedics, PGIMS, Rohtak, Haryana, India
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12
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Lasmar RB, Lasmar BP. The role of leiomyomas in the genesis of abnormal uterine bleeding (AUB). Best Pract Res Clin Obstet Gynaecol 2017; 40:82-88. [DOI: 10.1016/j.bpobgyn.2016.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 09/23/2016] [Indexed: 11/25/2022]
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13
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Abnormal Uterine Bleeding in Women with Infertility. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017. [DOI: 10.1007/s13669-017-0188-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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Sarvi F, Alleyassin A, Aghahosseini M, Ghasemi M, Gity S. Hysteroscopy: A necessary method for detecting uterine pathologies in post-menopausal women with abnormal uterine bleeding or increased endometrial thickness. Turk J Obstet Gynecol 2016; 13:183-188. [PMID: 28913119 PMCID: PMC5558290 DOI: 10.4274/tjod.66674] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 09/06/2016] [Indexed: 02/01/2023] Open
Abstract
Objective: To investigate the histologic and hysteroscopic findings of post-menopausal women with uterine bleeding and asymptomatic women with increased endometrial thickness equal or more than 5 mm. Materials and Methods: This cross-sectional study was performed between May 2014 and June 2015 on 110 post-menopausal women aged 40-82 years. The women were divided into two groups: Women with abnormal uterine bleeding (AUB group) and asymptomatic women with increased endometrial thickness (asymptomatic group). Results: Among the participants, 67 women had AUB and 43 women were asymptomatic. In the AUB group sensitivity, specificity, and positive and negative predictive values of hysteroscopy for normal findings were 98%, 100%, 100% and 90%, respectively. In the asymptomatic group, the same parameters were 98%, 100%, 100% and 85%, respectively. The sensitivity, specificity, and positive and negative predictive values of hysteroscopy for polyps and myomas were 100%. Also, the sensitivity, specificity, and positive and negative predictive values were 100% in hyperplasia cases found during hysteroscopy in both groups. Conclusion: Increased endometrial thickness in postmenopausal women with or without AUB is mostly due to benign lesions such as polyps and submucosal myomas. Hysteroscopy is a safe and reliable method for evaluating and treating these lesions.
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Affiliation(s)
- Fatemeh Sarvi
- Tehran University of Medical Sciences Shariati Hospital, Clinic of Endocrinology and Infertility, Tehran, Iran
| | - Ashraf Alleyassin
- Tehran University of Medical Sciences Shariati Hospital, Clinic of Endocrinology and Infertility, Tehran, Iran
| | - Marzieh Aghahosseini
- Tehran University of Medical Sciences Shariati Hospital, Clinic of Endocrinology and Infertility, Tehran, Iran
| | - Marzieh Ghasemi
- Zahedan University of Medical Sciences, Pregnancy Health Research Center, Department of Obstetrics and Gynecology, Zahedan, Iran
| | - Sima Gity
- Tehran University of Medical Sciences Shariati Hospital, Clinic of Endocrinology and Infertility, Tehran, Iran
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15
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Nelson AL, Vasquez L, Tabatabai R, Im SS. The yield of endometrial aspiration in women with various risk factors and bleeding abnormalities. Contracept Reprod Med 2016; 1:9. [PMID: 29201398 PMCID: PMC5693553 DOI: 10.1186/s40834-016-0020-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 04/23/2016] [Indexed: 12/27/2022] Open
Abstract
Background Even in the face of a substantial increase in the numbers of endometrial cancer cases and in the numbers of women who have risk factors, there is no clear agreement about the indications for assessing the endometria of women with abnormal bleeding or about the tools to use in that assessment. This study sought to determine in a group of high risk women with abnormal uterine bleeding, the probability that an outpatient endometrial aspiration would identify significant pathology. Methods Retrospective cohort study of the histology from endometrial aspirations performed from 2001 to 2008 for abnormal uterine bleeding at Harbor-UCLA Medical Center and its satellite public health clinics. Medical records were reviewed in detail to assess risk factors, descriptions of bleeding abnormalities and histologic results. Results The charts of 1601 women who underwent 1636 endometrial biopsies for a wide variety of abnormal uterine bleeding patterns yielded 73 (4.6 %) cases of endometrial carcinoma, 43 cases of atypical endometrial hyperplasia (2.7 %), for an overall yield of significant pathology of 7.2 %. Hyperplasia without atypia was found in another 83 cases (5.2 %). Obesity, diabetes and postmenopausal age are associated with an increased risk of significant pathology. Bleeding patterns were so poorly documented that analysis of yield by this factor should be viewed with caution. Conclusions The probability of detecting significant uterine pathology is greatest among obese, diabetic postmenopausal women with diabetes (26.3 %). Conversely, the probability of identifying significant pathology in younger women without risk factors is less than 2 %. For women who perceive their individualized risk estimate to be too small to justify an endometrial biopsy, it may be possible to offer oral higher dose progestin therapy on the condition that persistent abnormal bleeding will require more intensive evaluation. These estimates of absolute risk of being diagnosed with significant pathology on endometrial biopsy may be helpful to patients as they consider giving informed consent for the procedure.
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Affiliation(s)
- Anita L Nelson
- Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA USA.,1457 3rd Street, Manhattan Beach, CA 90266 USA
| | - Lisa Vasquez
- Department Obstetrics and Gynecology, Healthcare Partners, Montebello, CA USA
| | - Roya Tabatabai
- Department of Hematology and Oncology, Olive View-UCLA Medical Center, Sylmar, CA USA
| | - Samuel S Im
- Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, Torrance, CA USA
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Systemic hypertension and diabetes mellitus as predictors of malignancy among women with endometrial polyps: a meta-analysis of observational studies. Menopause 2016; 23:691-7. [DOI: 10.1097/gme.0000000000000602] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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A patient-preference cohort study of office versus inpatient uterine polyp treatment for abnormal uterine bleeding. ACTA ACUST UNITED AC 2016; 13:313-322. [PMID: 28003798 PMCID: PMC5133274 DOI: 10.1007/s10397-016-0946-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 04/05/2016] [Indexed: 11/01/2022]
Abstract
Uterine polyps can cause abnormal bleeding in women. Conventional practise is to remove them under general anaesthesia but advances in technology have made it possible to perform polypectomy in the office setting. We conducted a patient-preference study to explore women's preferences for treatment setting and to evaluate the effectiveness and treatment experience of women undergoing uterine polypectomy. Three hundred ninety-nine women with abnormal uterine bleeding who were found to have uterine polyps at diagnostic hysteroscopy were recruited. Office polypectomies were performed in office hysteroscopy clinics, and inpatient procedures were undertaken in operating theatres. Three hundred twenty-four of 399 (81 %) expressed a preference for office treatment. There was no difference found between office treatment and inpatient treatment in terms of alleviating abnormal uterine bleeding as assessed by patients and in improving disease-specific quality of life. Acceptability was lower and patient pain scores were significantly higher in the office group. When offered a choice of treatment setting for uterine polypectomy, patients have a preference for office over inpatient treatment. Ambulatory gynaecology services should be available within healthcare systems to meet patient demand.
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Nusair B, Al-Gudah M, Chodankar R, Abdelazim IA, Faza MA. Uterine Fibroid Mapping. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016. [DOI: 10.1007/s13669-016-0154-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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19
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Cooper NAM, Clark TJ, Middleton L, Diwakar L, Smith P, Denny E, Roberts T, Stobert L, Jowett S, Daniels J. Outpatient versus inpatient uterine polyp treatment for abnormal uterine bleeding: randomised controlled non-inferiority study. BMJ 2015; 350:h1398. [PMID: 25801579 PMCID: PMC4370502 DOI: 10.1136/bmj.h1398] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare the effectiveness and acceptability of outpatient polypectomy with inpatient polypectomy. DESIGN Pragmatic multicentre randomised controlled non-inferiority study. SETTING Outpatient hysteroscopy clinics in 31 UK National Health Service hospitals. PARTICIPANTS 507 women who attended as outpatients for diagnostic hysteroscopy because of abnormal uterine bleeding and were found to have uterine polyps. INTERVENTIONS Participants were randomly assigned to either outpatient uterine polypectomy under local anaesthetic or inpatient uterine polypectomy under general anaesthesia. Data were collected on women's self reported bleeding symptoms at baseline and at 6, 12, and 24 months. Data were also collected on pain and acceptability of the procedure at the time of polypectomy. MAIN OUTCOME MEASURES The primary outcome was successful treatment, determined by the women's assessment of bleeding at six months, with a prespecified non-inferiority margin of 25%. Secondary outcomes included generic (EQ-5D) and disease specific (menorrhagia multi-attribute scale) quality of life, and feasibility and acceptability of the procedure. RESULTS 73% (166/228) of women in the outpatient group and 80% (168/211) in the inpatient group reported successful treatment at six months (intention to treat relative risk 0.91, 95% confidence interval 0.82 to 1.02; per protocol relative risk 0.92, 0.82 to 1.02). Failure to remove polyps was higher (19% v 7%; relative risk 2.5, 1.5 to 4.1) and acceptability of the procedure was lower (83% v 92%; 0.90, 0.84 to 0.97) in the outpatient group Quality of life did not differ significantly between the groups. Four uterine perforations, one of which necessitated bowel resection, all occurred in the inpatient group. CONCLUSIONS Outpatient polypectomy was non-inferior to inpatient polypectomy. Failure to remove a uterine polyp was, however, more likely with outpatient polypectomy and acceptability of the procedure was slightly lower. TRIAL REGISTRATION International Clinical Trials Registry 65868569.
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Affiliation(s)
- Natalie A M Cooper
- Women's Health Research Unit, Queen Mary University of London, UK OPT Trial Office, Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, Robert Aitken Institute for Clinical Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | | | - Lee Middleton
- OPT Trial Office, Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, Robert Aitken Institute for Clinical Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Lavanya Diwakar
- Health Economics Unit, School of Health and Population Science, University of Birmingham, UK
| | - Paul Smith
- Birmingham Women's NHS Foundation Trust, Birmingham, UK School of Clinical and Experimental Medicine, University of Birmingham, UK
| | - Elaine Denny
- Centre for Health and Social Care Research, Birmingham City University, UK
| | - Tracy Roberts
- Health Economics Unit, School of Health and Population Science, University of Birmingham, UK
| | - Lynda Stobert
- School of Allied and Public Health Professions, Birmingham City University, UK
| | - Susan Jowett
- Health Economics Unit, School of Health and Population Science, University of Birmingham, UK
| | - Jane Daniels
- OPT Trial Office, Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, Robert Aitken Institute for Clinical Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Loiacono RMR, Trojano G, Del Gaudio N, Kardhashi A, Deliso MA, Falco G, Sforza R, Laera AF, Galise I, Trojano V. Hysteroscopy as a valid tool for endometrial pathology in patients with postmenopausal bleeding or asymptomatic patients with a thickened endometrium: hysteroscopic and histological results. Gynecol Obstet Invest 2015; 79:210-6. [PMID: 25765014 DOI: 10.1159/000371758] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 12/26/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study compares hysteroscopic and histopathological results in postmenopausal women with abnormal uterine bleeding (AUB) and asymptomatic postmenopausal women with a thickened endometrium. MATERIALS AND METHODS This is a retrospective study of 570 cases hysteroscopically examined between January 2008 and July 2012. The patients were followed up at the Istituto Tumori 'Giovanni Paolo II', Bari, Italy. RESULTS A total of 320 of the 570 cases were selected. The inclusion criteria were transvaginal ultrasound, hysteroscopy and endometrial biopsy. In the AUB group, if the hysteroscopy results were normal, a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 100, 95, 71 and 100%, respectively, were achieved, while in the asymptomatic group these values were 100, 97, 90 and 100%, respectively. For both the group with polyps and that with myomas, the sensitivity, specificity, PPV and NPV were 100%. For endometrial hyperplasia, hysteroscopy showed a sensitivity, specificity, PPV and NPV of 81, 96, 87 and 93%, respectively, in the AUB group, while in the asymptomatic group, the sensitivity was 60%, the specificity and PPV were 100%, and the NPV was 98%. The sensitivity of hysteroscopy for endometrial cancer was 63%, the specificity 97%, the PPV 77%, and the NPV 95%. CONCLUSIONS In postmenopausal women with a thickened endometrium with or without AUB, hysteroscopy allows for an accurate diagnosis in benign endometrial pathology. Hysteroscopy also allows directed biopsies of suspicious lesions, which is useful in malignant endometrial pathology.
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Affiliation(s)
- Rosalia Maria Rita Loiacono
- Division of Gynaecologic Oncology, Apulian Cancer Registry, National Cancer Research Centre, Istituto Tumori 'Giovanni Paolo II', Bari, Italy
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Alay A, Usta TA, Ozay P, Karadugan O, Ates U. Comparison of two modalities: a novel technique, 'chromohysteroscopy', and blind endometrial sampling for the evaluation of abnormal uterine bleeding. J Obstet Gynaecol Res 2014; 40:1407-14. [PMID: 24750264 DOI: 10.1111/jog.12341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 10/28/2013] [Indexed: 11/29/2022]
Abstract
AIM The objective of this study was to compare classical blind endometrial tissue sampling with hysteroscopic biopsy sampling following methylene blue dyeing in premenopausal and postmenopausal patients with abnormal uterine bleeding. MATERIAL AND METHODS A prospective case-control study was carried out in the Office Hysteroscopy Unit. Fifty-four patients with complaints of abnormal uterine bleeding were evaluated. Data of 38 patients were included in the statistical analysis. Three groups were compared by examining samples obtained through hysteroscopic biopsy before and after methylene blue dyeing, and classical blind endometrial tissue sampling. First, uterine cavity was evaluated with office hysteroscopy. Methylene blue dye was administered through the hysteroscopic inlet. Tissue samples were obtained from stained and non-stained areas. Blind endometrial sampling was performed in the same patients immediately after the hysteroscopy procedure. The results of hysteroscopic biopsy from methylene blue stained and non-stained areas and blind biopsy were compared. RESULTS No statistically significant differences were determined in the comparison of biopsy samples obtained from methylene-blue stained, non-stained areas and blind biopsy (P > 0.05). CONCLUSIONS We suggest that chromohysteroscopy is not superior to endometrial sampling in cases of abnormal uterine bleeding. Further studies with greater sample sizes should be performed to assess the validity of routine use of endometrial dyeing.
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Affiliation(s)
- Asli Alay
- Department of Obstetrics and Gynecology, Centrum Hospital, Istanbul, Turkey
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Dias DS, Bueloni-Dias FN, Dias R, Nahás-Neto J, Petri Nahás EA, Leite NJ, Custódio Domingues MA, Bueno Angela SP, Padovani CR. Usefulness of Clinical, Ultrasonographic, Hysteroscopic, and Immunohistochemical Parameters in Differentiating Endometrial Polyps From Endometrial Cancer. J Minim Invasive Gynecol 2014; 21:296-302. [DOI: 10.1016/j.jmig.2013.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 09/25/2013] [Accepted: 09/27/2013] [Indexed: 10/26/2022]
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Corbacioglu Esmer A, Akbayir O, Goksedef BPC, Gunduz N, Kisacık S, Dagdeviren H, Guraslan B, Ark C. Is there an appropriate cutoff age for sampling the endometrium in premenopausal bleeding? Gynecol Obstet Invest 2013; 77:40-4. [PMID: 24334971 DOI: 10.1159/000356959] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 11/04/2013] [Indexed: 11/19/2022]
Abstract
AIM To determine a cutoff age for endometrial evaluation in premenopausal abnormal uterine bleeding (AUB). METHODS Histopathology reports of endometrial sampling performed due to AUB in women aged 50 years or less were reviewed retrospectively. Histopathological findings were categorized into three groups as follows: group 1: hyperplasia without atypia + hyperplasia with atypia + malignancy, group 2: hyperplasia with atypia + malignancy, and group 3: malignancy. RESULTS Data from 2,516 patients were analyzed for this study. Overall, 13.5% of patients had endometrial hyperplasia without atypia, 1% of patients had hyperplasia with atypia and 0.6% of patients had malignant disease. Logistic regression revealed a significant difference in the odds ratios of group 1 in the age ranges of 40-45 and 45-50 years compared with <40 years (p = 0.001 and p = 0.01, respectively). There were no significant differences between the age groups for the odds ratio of group 2 and group 3. CONCLUSION There is no cutoff age for sampling the endometrium in order to detect hyperplasia with atypia and cancer in premenopausal women with AUB. Therefore, the management of AUB should be tailored to each patient regardless of age, incorporating all risk factors for malignant disease.
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Affiliation(s)
- Aytul Corbacioglu Esmer
- Department of Obstetrics and Gynecology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Lasmar BP, Lasmar RB. Endometrial polyp size and polyp hyperplasia. Int J Gynaecol Obstet 2013; 123:236-9. [DOI: 10.1016/j.ijgo.2013.06.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 06/07/2013] [Accepted: 08/27/2013] [Indexed: 11/30/2022]
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El-Hamarneh T, Hey-Cunningham AJ, Berbic M, Al-Jefout M, Fraser IS, Black K. Cellular immune environment in endometrial polyps. Fertil Steril 2013; 100:1364-72. [PMID: 23931965 DOI: 10.1016/j.fertnstert.2013.06.050] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 06/28/2013] [Accepted: 06/28/2013] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE To investigate the immune environment of endometrial polyps (EPs). DESIGN Prospective case-control study. SETTING Teaching hospital and university research laboratory. PATIENT(S) Reproductive-age women undergoing hysteroscopy dilation and curettage for benign indications. Samples were collected from women with (n = 23) and without (n = 40) EPs. INTERVENTION(S) Endometrial samples were immunohistochemically stained with antibodies against mast cells (MCs) and regulatory T cells (Tregs). MAIN OUTCOME MEASURE(S) Tryptase+, chymase+, and c-Kit+ MCs and Foxp3+ Tregs were quantified in EPs and polyp-adjacent, polyp-distant, and control endometrium. RESULT(S) Densities of all MC types were highly significantly increased in EPs compared with adjacent, distant, and control endometrium. Chymase+ and c-Kit+ MCs were increased in density in adjacent compared with control endometrium. c-Kit+ MCs were also increased in distant compared with control endometrium. Foxp3+ Treg density was increased in EPs compared with distant and control endometrium and decreased in distant compared with control endometrium. CONCLUSION(S) This study provides novel insights into localized disturbances in the cellular immune environment within EPs consistent with EPs being inflammatory lesions associated with MC overactivity. Tregs are likely to be recruited to EPs in an attempt to suppress the inflammatory process due to the greatly increased presence of MCs. These immunologic disturbances are likely to be involved in the causation of abnormal bleeding and infertility in premenopausal women with EPs, and their role in the pathophysiology requires further research.
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Affiliation(s)
- Tania El-Hamarneh
- Department of Obstetrics, Gynaecology and Neonatology, Queen Elizabeth II Research Institute for Mothers and Infants, University of Sydney, Sydney, New South Wales, Australia
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AAGL practice report: practice guidelines for the diagnosis and management of submucous leiomyomas. J Minim Invasive Gynecol 2012; 19:152-71. [PMID: 22381967 DOI: 10.1016/j.jmig.2011.09.005] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 09/08/2011] [Indexed: 11/21/2022]
Abstract
Submucous leiomyomas or myomas are commonly encountered by gynecologists and specialists in reproductive endocrinology and infertility with patients presenting with 1 or a combination of symptoms that include heavy menstrual bleeding, infertility, and recurrent pregnancy loss. There exists a variety of interventions that include those performed under hysteroscopic, laparoscopic and laparotomic direction; an evolving spectrum of image guided procedures, and an expanding number of pharmaceutical agents, each of which has value for the appropriately selected and counseled patient. Identification of the ideal approach requires the clinician to be intimately familiar with a given patient's history, including her desires with respect to fertility, as well as an appropriately detailed evaluation of the uterus with any one or a combination of a number of imaging techniques, including hysteroscopy. This guideline has been developed following a systematic review of the evidence, to provide guidance to the clinician caring for such patients, and to assist the clinical investigator in determining potential areas of research. Where high level evidence was lacking, but where a majority of opinion or consensus could be reached, the guideline development committee provided consensus recommendations as well.
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Abstract
Abnormal uterine bleeding is one of the most common presenting complaints encountered in a gynecologist's office or primary care setting. The availability of diagnostic tools, such as ultrasound, endometrial sampling, and diagnostic hysteroscopy has made it possible to promptly diagnose and treat an increasing number of menstrual disorders in an office setting. The incorporation of newer medical therapies: antifibrinolytic drugs, shorter hormone-free interval oral contraceptive pills, and levonorgestrel inserts along with office minimally invasive treatments operative hysteroscopy and endometrial ablations have proven to be powerful therapeutic arsenals to provide short-term relief of abnormal uterine bleeding, and potentially, avoiding or delaying the hysterectomy.
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Bastos de Souza CA, Schmitz C, Genro VK, Martins A, Scheffel C, Oppermann ML, Cunha Filho JS. Histeroscopia ambulatorial em casos de abortamento consecutivo. Rev Assoc Med Bras (1992) 2011. [DOI: 10.1590/s0104-42302011000400013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Lee DO, Jung MH, Kim HY. Prospective comparison of biopsy results from curettage and hysteroscopy in postmenopausal uterine bleeding. J Obstet Gynaecol Res 2011; 37:1423-6. [DOI: 10.1111/j.1447-0756.2011.01558.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Török P, Major T. [Office hysteroscopy: a new examination method in gynecological practice]. Orv Hetil 2011; 152:51-4. [PMID: 21177231 DOI: 10.1556/oh.2011.28997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Hysteroscopy is a widely used endoscopic method, the "gold standard" for the examination of uterine cavity changes. Office hysteroscopy is an intervention that makes the accomplishment of ambulant examination, opposite to the traditional method. Due to the small diameter of the device the anesthesia is unnecessary, because there is no need of the dilatation of the cervix. Indications of the examination are wide-ranging. Besides the abnormal uterine bleeding, it can be used in the examination of infertility, and those intrauterine changes (polyp, submucosus myoma, adhesion), that were diagnosed by other imagining methods that cause infertility complaints. The aim of our present review is recommend the use of this method because it does not need any preparation and it is minimal invasive. The use of traditional method that needs longer preparation, observation, anesthesia and operating theatre, is only suggested in cases of proven pathology.
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Affiliation(s)
- Péter Török
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, Szülészeti és Nőgyógyászati Klinika, Debrecen Nagyerdei krt. 98., 4032.
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Surico D, Vigone A, Bonvini D, Tinelli R, Leo L, Surico N. Narrow-band imaging in diagnosis of endometrial cancer and hyperplasia: a new option? J Minim Invasive Gynecol 2010; 17:620-5. [PMID: 20579943 DOI: 10.1016/j.jmig.2009.10.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Revised: 10/23/2009] [Accepted: 10/29/2009] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE To estimate whether the use of narrow-band imaging (NBI) hysteroscopy increases concordance between visual identification and a histologic diagnosis of endometrial cancer and hyperplasia. DESIGN Prospective study (Canadian Task Force classification: II-2). SETTING Department of obstetrics and gynecology, University of Eastern Piedmont, Novara, Italy. PATIENTS 209 consecutive patients with abnormal uterine bleeding. INTERVENTIONS White-light hysteroscopy and NBI hysteroscopy followed by direct biopsy. MEASUREMENTS AND MAIN RESULTS The sensitivity and specificity of conventional hysteroscopy in predicting a diagnosis of cancer and hyperplasia were, respectively, 84.21% (95% confidence interval [CI], 79.27-89.15) and 99.47% (95% CI, 98.49-100.0), and 64.86% (95% CI, 58.39-71.34) and 98.77% (95% CI, 97.27-100.0), and of NBI hysteroscopy were 94.74% (95% CI, 91.71-97.76) and 97.89% (95% CI, 95.95-99.84), and 78.38% (95% CI, 72.8-83.96) and 97.67% (95% CI, 96.63-99.72). The concordance of conventional and NBI hysteroscopy with the histopathologic findings (measured using the Cohen kappa) was, respectively, 88.80% (95% CI, 86.2%-96.3%) and 91.78% (95% CI, 89.6%-98.2%), a difference of 2.98% (95% CI, 0-9) in favor of NBI. CONCLUSION Narrow-band imaging hysteroscopy can accurately predict a histologic diagnosis of endometrial cancer or hyperplasia.
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Affiliation(s)
- Daniela Surico
- Advanced Gynecological Oncology Centre, Department of Obstetrics, Novara, Italy.
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Vilos GA, Tureanu V, Garcia M, Abu-Rafea B. The levonorgestrel intrauterine system is an effective treatment in women with abnormal uterine bleeding and anticoagulant therapy. J Minim Invasive Gynecol 2009; 16:480-4. [PMID: 19573825 DOI: 10.1016/j.jmig.2009.04.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Revised: 04/28/2009] [Accepted: 04/30/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the efficacy of levonorgestrel intrauterine systems (LNG-IUS) in obese women with AUB on anticoagulant therapy. DESIGN Prospective observational case series (Canadian Task Force Classification II-3). SETTING University affiliated teaching hospital. PATIENTS Premenopausal women on Warfarin therapy. INTERVENTIONS From January 2002 through January 2007, 10 women were identified from the senior author's clinical practice (G.A.V.). After clinical assessment, including Papanicolaou smear, endometrial biopsy, and pelvic sonography, the LNG-IUS was placed to treat their AUB. MEASUREMENTS AND MAIN RESULTS The median and range of age, parity, and body mass index were 45 years (34-49), 1 (0-4), and 38 kg/m(2) (26-52), respectively. All women were receiving warfarin therapy (4-12.5 mg/d) for previous venous thromboembolism. Some patients had additional comorbid conditions and were at high risk for traditional medical or surgical therapies. After placement of the LNG-IUS, all women reported menstrual reduction at 3 and 6 months. By 12 months, 1 woman with large fibroids expelled the LNG-IUS and was treated with transfemoral uterine artery embolization. Two women had amenorrhea, and 7 had hypomenorrhea. At 2 to 5 years, 1 woman expelled the LNG-IUS and hysterectomy indicated extensive adenomyosis in a 195-g uterus, and 1 woman had hysteroscopic endometrial ablation, 4 were menopausal, 2 had amenorrhea, and 1 had hypomenorrhea. In the 5 women with uterine fibroids measuring 4.2 to 147 cm(3), the fibroids were reduced in volume by approximately 75% in 2, were no longer detectable in 1, were subsequently shown to be adenomyoma in 1, and required uterine artery embolization in 1. CONCLUSION In properly assessed and selected obese, premenopausal women with AUB receiving warfarin therapy and at high risk for traditional therapies, the LNG-IUS was an effective treatment in 70% of patients.
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Affiliation(s)
- George A Vilos
- St. Joseph's Health Care, Department of Obstetrics and Gynecology, The University of Western Ontario, London, Ontario, Canada.
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Current World Literature. Curr Opin Obstet Gynecol 2009; 21:353-63. [DOI: 10.1097/gco.0b013e32832f731f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Miscellaneous Uterine Malignant Neoplasms Detected during Hysteroscopic Surgery. J Minim Invasive Gynecol 2009; 16:318-25. [DOI: 10.1016/j.jmig.2009.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Revised: 02/03/2009] [Accepted: 02/05/2009] [Indexed: 11/21/2022]
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