27 research outputs found
Diagnostic evaluation of the endometrium in postmenopausal bleeding: an evidence-based approach
No full textAbstract not availableN. van Hanegem, M.C. Breijer, K.S. Khan, T.J. Clark, M.P.M. Burger, B.W.J. Mol, A. Timmerman
Prediction models in women with postmenopausal bleeding: a systematic review
No full textPostmenopausal bleeding is associated with an elevated risk of having endometrial cancer. The aim of this review is to give an overview of existing prediction models on endometrial cancer in women with postmenopausal bleeding. In a systematic search of the literature, we identified nine prognostic studies, of which we assessed the quality, the different phases of development and their performance. From these data, we identified the most important predictor variables. None of the detected models completed external validation or impact analysis. Models including power Doppler showed best performance in internal validation, but Doppler in general gynecological practice is not easily accessible. We can conclude that we have indications that the first step in the approach of women with postmenopausal bleeding should be to distinguish between women with low risk versus high risk of having endometrial carcinoma and the next step would be to refer patients for further (invasive) testing.Nehalennia van Hanegem, Maria C Breijer, Brent C Opmeer, Ben WJ Mol & Anne Timmerman
The diagnostic work-up of women with postmenopausal bleeding
No full textIn this thesis we describe the diagnostic work-up that can be used to diagnose or exclude endometrial cancer in women with postmenopausal bleeding. Despite the many studies investigating this, there is no consensus in literature. The diagnostic steps vary in different guidelines, depending on the structure of patient flow in different settings and healthcare systems, as well as the availability of specific procedures.One important question in this thesis is if we can reassure women with a benign result of endometrial sampling. Is it (cost-)effective to diagnose and remove endometrial polyps to prevent recurrent bleeding? And is it necessary to diagnose and remove a polyp to detect a possible endometrial (pre)cancer?From the randomised trial described in this thesis, we can conclude that in women with PMB, a thickened endometrium and benign endometrial sampling, operative hysteroscopy does not reduce recurrent bleeding. Yet, hysteroscopy detected focal endometrial (pre) cancer in 6% of women who had benign endometrial sampling. This finding indicates that in these women, further diagnostic work-up is warranted to detect focal (pre)cancers missed by endometrial sampling. Furthermore, we can conclude that the diagnostic accuracy of endometrial sampling is lower that we thought based on previous literature. We have also looked into the value of predictionmodels, which we could use to select women with a high risk of endometrial cancer for further diagnostic work-up based on their patient-characteristics. We can conclude that until now, no predictionmodels are available which can select women based on their characteristics, without on the other hand missing women with endometrial cancer
The diagnostic work-up of women with postmenopausal bleeding
No full textIn this thesis we describe the diagnostic work-up that can be used to diagnose or exclude endometrial cancer in women with postmenopausal bleeding. Despite the many studies investigating this, there is no consensus in literature. The diagnostic steps vary in different guidelines, depending on the structure of patient flow in different settings and healthcare systems, as well as the availability of specific procedures. One important question in this thesis is if we can reassure women with a benign result of endometrial sampling. Is it (cost-)effective to diagnose and remove endometrial polyps to prevent recurrent bleeding? And is it necessary to diagnose and remove a polyp to detect a possible endometrial (pre)cancer? From the randomised trial described in this thesis, we can conclude that in women with PMB, a thickened endometrium and benign endometrial sampling, operative hysteroscopy does not reduce recurrent bleeding. Yet, hysteroscopy detected focal endometrial (pre) cancer in 6% of women who had benign endometrial sampling. This finding indicates that in these women, further diagnostic work-up is warranted to detect focal (pre)cancers missed by endometrial sampling. Furthermore, we can conclude that the diagnostic accuracy of endometrial sampling is lower that we thought based on previous literature. We have also looked into the value of predictionmodels, which we could use to select women with a high risk of endometrial cancer for further diagnostic work-up based on their patient-characteristics. We can conclude that until now, no predictionmodels are available which can select women based on their characteristics, without on the other hand missing women with endometrial cancer
Severe acute maternal morbidity in asylum seekers: a two-year nationwide cohort study in the Netherlands.
No full textResearch into fetal development and medicin
Psychosociale kwetsbaarheid bij dyspareunie: spelen epigenetische veranderingen daarbij een rol?
No full textEndometrial sampling before or after saline contrast sonohysterography in women with postmenopausal bleeding (ESPRESSO trial): A multicenter randomized controlled trial
No full textIntroduction The aim of this study is to evaluate the quality of the endometrial sample obtained by office endometrial aspiration when performed before or after saline contrast sonohysterography (SCSH) in women with postmenopausal bleeding and a thickened endometrium. To conduct a complete, minimally invasive and cost-effective diagnostic workup in women with postmenopausal bleeding and a thickened endometrium, ideally both the office endometrial sampling and SCSH are performed. However, it is not known whether both tests affect each other when performed one after another.Material and methods Women with postmenopausal bleeding and an endometrial thickness >4 mm were eligible. Women were randomized into two groups: one group received endometrial aspiration before SCSH, the other group received SCSH before endometrial aspiration. The primary outcome was the proportion of sufficient endometrial samples. Reliability of the SCSH images and pain during procedures were secondary outcomes.Results During the inclusion period, 513 eligible women with postmenopausal bleeding visited the participating hospitals, 293 of whom received information about the study. Of these women, 232 (79%) agreed to participate. In the SCSH-aspiration group, 65 women (59%) had a sufficient endometrial sample compared with 70 (67%) in the aspiration-SCSH group (odds ratio 1.46, 95% CI 0.83-2.54, P = .19). The proportion of reliable sonographic images was significantly higher in the SCSH-aspiration group (n = 88, 87%) compared with the aspiration-SCSH group (n = 71, 74%) (OR 2.38, 95% CI 1.38-4.99, P = .02) in the per protocol analysis.Conclusions This study shows that the quality of an endometrial sample in women with postmenopausal bleeding is not affected by SCSH. Both procedures can be performed in one outpatient visit to perform an optimal diagnostic workup
Re: Diagnostic work up for postmenopausal bleeding: a randomised controlled trial Evaluation of postmenopausal women by hysteroscopy Reply
No full textEndometriosis and Sexual Quality of Life
No full textIntroduction: Endometriosis is a benign gynecological disease with a high disease burden and significant, multifaceted impact on health-related quality of life (HRQoL) and sexual quality of life (SQoL).Aim: To explore which patientand disease-specific characteristics were independently associated with SQoL.Methods: A literature search was carried out to identify characteristics with an evidence-based or hypothesized effect on SQoL. Subsequently, data on HRQoL in women with endometriosis (n = 224), collected between 2013 and 2018 in a prospective longitudinal Dutch cohort study performed in 7 referral centers, were used to perform a cross-sectional cohort study. Data were collected using an online self-administered survey including the validated Endometriosis Health Profile-30. Inclusion criteria were recently diagnosed endometriosis patients or newly referred patients with a clinical diagnosis of endometriosis. Patients were excluded in case of incomplete answers on the SQoL questions. Univariate analyses and multiple linear regression analyses were performed.Outcomes: SQoL, measured by the 5-item "sexual intercourse" dimension score of the modular Endometriosis Health Profile-30 questionnaire, was the primary outcome with scores ranging from 0 to 100 (0 indicating the best and 100 indicating the worst health status).Results: Based on a literature search, 29 characteristics potentially associated with SQoL were selected from the survey and included in the analyses. In total, 192 women (mean age 36 years) met the inclusion criteria. The majority of women (86.5%) had had intercourse in the period before completing the survey and the study population showed a mean SQoL score of 47.5 +/- 29.6, indicating moderate SQoL. Worse SQoL was independently associated with dyspareunia (P <.001), worse HRQoL (P = .001), severity of dysmenorrhea (P = .017), and unemployed work status (P = .022).Conclusion: In a cohort of women with endometriosis, worse SQoL was significantly and independently associated with the presence of dyspareunia, more severe dysmenorrhea, worse HRQoL, and unemployed work status. van Poll M, van Barneveld E, Aerts L, et al. Endometriosis and Sexual Quality of Life. Sex Med 2020;8:532-544. Copyright (c) 2020, The Authors. Published by Elsevier Inc. on behalf of the International Society for Sexual Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).</p
