Infertility: an out-of-the-box cause of postmenopausal endometrial thickening

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Three of 2000 diagnostic hysteroscopies revealed residual fetal bony fragments in women with abnormal uterine bleeding. Removal of bony fragments by hysteroscopy is associated with therapeutic success.
Objectives: To present two cases in which foreign bodies in the uterine cavity had a contraceptive effect for the duration of their presence in utero. Case: One case of endometrial osseous metaplasia and another case with unabsorbed suture material after a caesarean section resulted in foreign bodies acting like an intrauterine contraceptive. Ultrasound was used to diagnose the conditions, and hysteroscopy to remove the foreign bodies. Conclusion: Foreign intrauterine bodies should be considered in cases of infertility.
Postmenopausal bleeding (PMB) is a common complaint in general gynecological practice. Women with PMB have around a 10% chance of having endometrial carcinoma and therefore PMB always needs further evaluation. This article summarizes the reviews on the subject and provides an overview of the use of diagnostic tools in patients with PMB. Four types of diagnostic test are described: sonographic measurement of endometrial thickness, endometrial sampling, hysteroscopy and saline infusion sonography. All four have been independently shown to be accurate in excluding endometrial cancer. However, neither in systematic reviews nor in international guidelines is consensus found regarding the sequence in which these methods should be employed in women with PMB. For measurement of endometrial thickness in symptomatic women, a cut-off value of 3mm is recommended, but the cost-effectiveness of this strategy has yet to be shown. Research should now focus on the incorporation of individual patient characteristics and pre-test probabilities for cancer in algorithms for the investigation of PMB, and the most cost-effective sequenced combination of the four types of test.