••• Chapter 24^ Functional and Dysfunctional Uterine Bleeding^247
❍ What percentage of women develop amenorrhea following endometrial ablation?
Approximately 60%.
❍ What percentage of women will develop improvement in their menstrual blood loss following endometrial
ablation?
Up to 90%.
❍ What percentage of patients after endometrial ablation require further procedures?
Hysterectomy or repeat endometrial ablation is required in 20% to 40% of patients within 4 years.
❍ What is the most common reason for endometrial ablation to fail?
Adenomyosis.
❍ In what clinical situations should estrogen be the initial choice of treatment for abnormal uterine bleeding?
(1) When the bleeding has been heavy for many days, (2) when endometrial sampling yields minimal tissue,
(3) when the patient has been on progestins and the endometrium is atrophic, and (4) when follow-up is
uncertain, because estrogen will temporarily stop all categories of DUB.
❍ What is the role of curettage in the treatment of DUB?
It is effective in controlling acute hemorrhage when hormonal therapy fails.
❍ What are common clinical conditions present when medical therapy fails to control menorrhagia?
Submucous fibroids, endometrial polyps, hyperplasia, or cancer.
❍ How can one increase sensitivity and specificity of transvaginal ultrasound in assessment of endometrial
cavity?
By performing saline infusion sonography with instillation of sterile saline into the endometrial cavity. Sensitivity
increases from 75% to 93%, specificity from 76% to 94%.
❍ What is the probability of endometrial cancer in a postmenopausal woman with vaginal bleeding
with endometrial thickness <4 mm?
0.5%.
❍ What is the probability of endometrial cancer in postmenopausal woman with vaginal bleeding after
a negative hysteroscopy?
0.4% to 0.5%.
❍ What is the probability of endometrial cancer in postmenopausal woman with vaginal bleeding with
endometrial thickness >10 mm?
10% to 20%.
❍ What are the diseases that may mimic vaginal bleeding?
Urethritis, bladder cancer, urinary tract infection, inflammatory bowel disease, and hemorrhoids.