Introduction/Background The Dutch diagnostic guideline for women with a first episode of postmenopausal bleeding (PMB) was updated in 2015, and aims at detecting (pre)malignancies and uterine polyps (figure 1). The main aim of this study was to evaluate the adherence to the guideline. Secondly, if recurrent bleeding and detection of (pre)malignancies in the first year of follow up relates to guideline-adherence or violation.
Methodology We performed a multicentre, prospective cohort study in four hospitals in The Netherlands including women undergoing an aspiration endometrial biopsy for a first episode of PMB after providing written informed consent. Women with a benign or insufficient sample were assigned to the diagnostic workup group (DWG) when the workup was according to the guideline. If not, women were assigned to the protocol violation group (PVG). Statistical analysis was performed with SPSS24. Central study approval was obtained at the ErasmusMC, (MEC 2015-740), the study was registered on www.trialregister.nl (NL7608).
Results From 01.2016 till 02.2019 we enrolled 341 women, of which 78% had an increased or not measurable endometrial thickness and a benign or insufficient endometrial sample. The guideline was subsequently followed in 52%, revealing a (pre)malignancy in 6% of these women. In the DWG, 8.7% experienced recurrent bleeding within the first year, not attributable to a (pre)malignancy (figure 2). In the PVG, recurrent bleeding occurred in 15.6% (RR 0.60; 95% CI 0.29–1.21), with detection of a (pre)malignancy in three cases (RR 0.27; CI 95% 0.02–4.88) (table 1).
Conclusion In women with a first episode of postmenopausal bleeding, an increased or not measurable endometrial thickness, and a benign or insufficient endometrial sample the guideline was followed in 52%. In women with guideline violation more recurrent bleeding and (pre)malignancies were seen in the first year of follow-up, although significance was not reached.
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