Uterine Cavity Assessment and Endometrial Hormonal Receptors in Women With Peri and Post Menopausal Bleeding
Condition: Vaginal Bleeding
MeSH terms: Uterine Hemorrhage; Hemorrhage
Study type: Interventional

Summary: 
      100 women with abnormal uterine bleeding (peri and postmenopausal) were subjected to
      transvaginal ultrasound , saline sonohysterography , Diagnostic hysteroscopy and fractional
      curettage followed by histopathological examination and immunohistochemical analysis for
      estrogen and progesterone receptors.
    

Detailed description: 
      Conventional TVUS will be done to all participants to measure the uterine size & endometrial
      thickness and other pathology. TVUS will be done with an empty bladder in the lithotomy
      position using an endovaginal curved linear probe (EV 4-9/10 ED) with frequency 4-9 MHz.

      SIS will be performed for all patients at the same setting of TVUS. With the patient in the
      lithotomy position, . A 6 or 8 French Foley's catheter will be inserted through the external
      cervical os into the cervical canal. Its balloon tip will be inflated with 2-3 mL of saline,
      depending on patient comfort, to help hold it in place. The speculum was then removed.

      The vaginal probe was then reinserted and a 5-10 mL syringe filled with sterile saline was
      attached to the catheter. Fluid will be instilled while the transducer moved from side to
      side (cornua to cornua) in a long-axis projection then the transducer was rotated 90° into an
      axial plane. More fluid was instilled while fanning down toward the endocervical canal and up
      toward the uterine fundus to obtain a detailed survey of the endometrium. Every portion of
      the uterine cavity should be imaged, to exclude any focal abnormality as polyps, myomas,
      hyperplasia, and carcinoma. Any detected intrauterine pathology is described; including its
      shape, size and site.

      The hysteroscope used in this study is a rigid continuous flow panoramic hysteroscope, 25 cm
      in length, 4 mm in diameter with an outer sheath 5 mm diameter and 30° fibro-optic lens.

      The technique used to provide constant uterine distention will be by attaching plastic bags
      of saline. Infusion pressure was elevated by pneumatic cuff under manometric control at a
      pressure of 100-120 mmHg.

      Detailed hysteroscopic examination will be performed under general anesthesia with the
      patient in the lithotomy position, The thickness, colour, aspect and vasculature of the
      mucous membrane lining the uterine cavity will be observed and recorded.

      Endometrial curettage will be done to all patients, and specimens were fixed in Formalin 10%
      solution for histopathological examination. Patients in whom endometrial polyps were found by
      hysteroscopy, had polypectomy performed before curettage. The first sample will be taken from
      the endocervical canal before hysteroscopy or cervical dilatation. Following diagnostic
      hysteroscopy, cervical dilatation u. A sharp curette will be introduced into the uterine
      cavity, and curettage will be done starting with the fundus then posterior, anterior, right
      and left lateral walls consecutively.

      Histopathological examination. All curettage & polypectomy specimens were embedded in
      paraffin wax, then slides will be prepared to be stained by the conventional Haematoxylin and
      Eosin (H & E) stain.

      Detection of estrogen & progesterone receptors in the specimens (formalin-fixed, paraffin
      wax-embedded) using immunohistochemical staining which will be carried out by using the Dako
      ER/PR pharmDx™ Kit which specifically detects the ERα protein as well as the PR-A protein
      located in the cell nuclei of ER and PR expressing cells, respectively.
    

Intervention name(s): hystroscopy
Intervention type(s): Procedure
Intervention description(s): Detailed hysteroscopic examination under general anesthesia Once the cavity entered, a panoramic view of the uterine cavity then systematic; first the fundus, then anterior, posterior and lateral walls of the uterus consecutively, ending by visualization of the uterine -tubal junctions, The thickness, colour, aspect and vasculature of the mucous membrane lining the uterine cavity was observed and recorded. If there is any intrauterine pathology detected; the shape, size and site were estimated.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: perimenopausal bleeding; postmenopausal bleeding; hysteroscopy; Steroid receptors