An audit of true prevalence of intra-uterine pathology: The hysteroscopical findings controlled for patient selection in 1202 patients with abnormal uterine bleeding

We evaluated the true prevalence of intra-uterine abnormalities in patients with abnormal uterine bleeding, by analysis of the hysteroscopic findings, controlled for patient selection, in a 4-year observational study (1989-1992) of 1202 patients attending a large teaching hospital. Diagnostic hysteroscopy was performed on an outpatient basis with local anaesthesia. Findings were analysed separately for both 962 primary or less selected and 240 secondary or more selected referrals. Significant differences were found between primary and secondary referred premenopausal patients concerning a normal endometrium/uterine cavity (63.3 vs. 44.2%) and submucous myomas (14.7 vs, 42.9%). Menorrhagia, compared with metrorrhagia, significantly increased the chance of the presence of submucous myomas only in secondary referred patients. Dysmenorrhoea was associated with a higher prevalence of submucous myomas in all patients. The prevalence of hysteroscopic findings is significantly biased without controlling for patient selection. Application and comparison to the population in general practice can now be considered trustworthy. As overall 415 of 962 patients (43.1%) referred by the general practitioner for abnormal uterine bleeding are expected to have some kind of intra-uterine pathology, the recommendation, that the management of abnormal uterine bleeding should include diagnostic hysteroscopy, is strongly supported.