Postmenopausal bleeding:: management by transvaginal ultrasound scan or outpatient hysteroscopy?

Objective The aim of this study was to determine whether transvaginal ultrasound scan or outpatient hysteroscopy represents a more efficient way to investigate postmenopausal bleeding. Design This was a retrospective study by case note review of women with postmenopausal bleeding (PMB), investigated in clinic A by transvaginal ultrasound scan (TVS) and endometrial biopsy, and in clinic B by outpatient hysteroscopy, between April and October 2000. Women on hormone replacement therapy were excluded. Setting Two teaching hospital gynaecological units in one city. Results During the study period 166 women were referred to the clinics; case notes for 10 patients were missing; 84 patients underwent TVS, and 72 outpatient hysteroscopy. The number of visits was significantly lower in the hysteroscopy group, with 13.8% of women making two or more visits compared with 44% in the TVS group (P = 0.01). Of the women investigated by hysteroscopy, 72.2% were discharged after the first visit compared with 61.9% in the TVS group (P less than or equal to 0.01). Therefore the time from first visit to clinic to clinical diagnosis was significantly shorter after hysteroscopy, with a mean of 2.3 days compared with 8.8 days in the TVS group (P less than or equal to 0.01). Fewer investigations were required in the hysteroscopy group, with seven women (9.7%) needing more than two investigations compared with 24 (28.6%) in the TVS group. TVS identified other pelvic pathology in five women (6%). Conclusions Hysteroscopy appears more efficient than TVS for the investigation of postmenopausal bleeding. This results in fewer clinic visits and investigations, a reduction in waiting time for patients and possibly less wasting of resources.