{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:15:03Z","timestamp":1789578903028,"version":"build-2803163510"},"reference-count":34,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2016,5,26]],"date-time":"2016-05-26T00:00:00Z","timestamp":1464220800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the effectiveness of hysteroscopy for the detection and treatment of endometrial polyps versus expectant management in women with postmenopausal bleeding (<jats:styled-content style=\"fixed-case\">PMB<\/jats:styled-content>), a thickened endometrium and benign endometrial sampling.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Multicentre, randomised controlled trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Three academic hospitals and nine non\u2010academic teaching hospitals in the Netherlands.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Women with <jats:styled-content style=\"fixed-case\">PMB<\/jats:styled-content>, an endometrial thickness &gt;4\u00a0mm and benign result from endometrial sampling.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Women were randomised to either further diagnostic workup by hysteroscopy (preceded by saline infusion sonography) or expectant management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcomes<\/jats:title><jats:p>The primary outcome measure was recurrence of <jats:styled-content style=\"fixed-case\">PMB<\/jats:styled-content> within a year after randomisation. Secondary outcome measures were time to recurrent bleeding and recurrent bleeding after more than 1\u00a0year. In the hysteroscopy group, the presence of polyps and the results of their histology were registered.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Between January 2010 and October 2013, 200 women were randomised; 98 to hysteroscopy and 102 to expectant management. Within 1\u00a0year a total of 15 women (15.3%) in the hysteroscopy group experienced recurrent bleeding, versus 18 (18.0%) in the expectant management group (relative risk 0.85 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.46\u20131.59). In the hysteroscopy group, 50\/98 (51%) polyps were diagnosed of which 6\/98 (6%) showed evidence of endometrial (pre)malignancy; final pathology results after hysterectomy showed three women with hyperplasia with atypia and three women with endometrial cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In women with <jats:styled-content style=\"fixed-case\">PMB<\/jats:styled-content>, a thickened endometrium and\u00a0benign endometrial sampling, operative hysteroscopy does\u00a0not\u00a0reduce recurrent bleeding. Hysteroscopy detected focal\u00a0endometrial (pre)malignancy in 6% of women who had\u00a0benign endometrial sampling. This finding indicates that in\u00a0these women, further diagnostic workup is warranted to detect\u00a0focal (pre)malignancies, missed by blind endometrial sampling.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>In women with <jats:styled-content style=\"fixed-case\">PMB<\/jats:styled-content>, hysteroscopy does not reduce recurrent bleeding but is warranted to detect focal malignancy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.14126","type":"journal-article","created":{"date-parts":[[2016,5,26]],"date-time":"2016-05-26T13:11:27Z","timestamp":1464268287000},"page":"231-240","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":61,"title":["Diagnostic workup for postmenopausal bleeding: a randomised controlled trial"],"prefix":"10.1111","volume":"124","author":[{"given":"N","family":"van Hanegem","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology Academic 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