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Re: Postmenopausal bleeding--**update**From: Michael J. Wolpmann, M.D. (elvis@llano.net)Sat Mar 29 16:05:07 1997
At Fri, 28 Mar 1997, Garry E. Siegel, M.D. wrote: > >Thanks to all for your opinions. After talking with this woman today, >and going over saline sonography (my choice) versus Hysteroscopy/D and >C, she wants the certainty of the latter. Given her risk >factors--nullip, Obese, IDDM, Hypertension--I have a hard time not doing >a D and C/Hysterscopy, which remains the standard of care. > >Garry > If you already have an ultrasound showing nothing hyperechoic in the uterine cavity, ie sumucosal fibroid or polyp, then hysteroscopy/d& c is unlikely to end this patients bleeding problem. If endometrium was able to be measured, did she have continuous stripe, or is there an abnormality of the endometrium? If stripe fully visualized and normal, even without saline, your chances of finding pathology are pretty small at H-scope. You already have loads of benign tissue as she will probably painfully recount to you(4 quadrant Novak). The correlation with d & c is above 99%. Would bet my lottery ticket she has no cancer. Place her on continous HRT and wait. May need to up progestin component if bleeding recurs(she has elevated peripheral E2). Good luck.
-- Michael
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