Patients’ preferences in the evaluation of postmenopausal bleeding

• Published in: BJOG : an international journal of obstetrics and gynaecology 2007-09, Vol.114 (9), p.1146-1149
• Main Authors: Timmermans, A, Opmeer, BC, Veersema, S, Mol, BWJ
• Format: Article
• Language: English
• Subjects: Attitudes; Biological and medical sciences; Diagnosis; Diagnostic tests; Endometrial cancer; Endometrial Neoplasms - diagnosis; Endometrial Neoplasms - psychology; Endometriosis; Female; Gynecology; Gynecology. Andrology. Obstetrics; Hemorrhage; Humans; Hysteroscopy - psychology; Medical sciences; Patient Satisfaction; patients’ preferences; Polyps - diagnosis; Polyps - psychology; postmenopausal bleeding; Postmenopause - psychology; Recurrence; Risk Factors; Uterine Hemorrhage - etiology; Uterine Hemorrhage - psychology
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/j.1471-0528.2007.01424.x

Objective  To assess patients’ preferences for diagnostic management of postmenopausal bleeding (PMB). Design  A structured interview. Setting  A teaching hospital with office hysteroscopy facilities. Population  Thirty‐nine women with PMB and with a completed work‐up including an office hysteroscopy. Methods  A structured interview was taken from 39 women who had had an office hysteroscopy in the diagnostic work‐up for PMB. Women were informed about the probability of endometrial carcinoma versus benign disease and about advantages and disadvantages of different diagnostic strategies, i.e. expectant management after ultrasound or complete diagnostic work‐up, including invasive procedures. Main outcome measures  Women were informed about the probability of endometrial carcinoma versus benign disease and about advantages and disadvantages of different diagnostic strategies, i.e., expectant management after ultrasound or complete diagnostic work‐up including invasive procedures. Women were asked to make a trade‐off between different options. Results  Most women wanted to be 100% certain that carcinoma could be ruled out. Only 5% of the women were willing to accept more than 5% risk of false reassurance. If the risk of recurrent bleeding due to benign disease exceeded 25%, the majority of women would prefer immediate diagnosis and treatment of benign lesions. Conclusion  Women with PMB are prepared to undergo hysteroscopy to rule out any risk on cancer. This finding implicates that the measurement of endometrial thickness with transvaginal ultrasound as a first‐line test in the assessment of PMB should be reconsidered.