In her doctoral thesis, gynecological oncologist Lena van Doorn concludes that gynecologists sometimes carry out extra or unnecessarily distressing or costly tests on menopausal women experiencing vaginal blood loss.
A biopsy was done in 13 percent of the patients in her doctoral research, even though according to the treatment guidelines this is unnecessary. The tests were unnecessarily extensive in 10 percent of the cases. Van Doorn recommends that gynecologists abide by the guidelines.
A menopausal woman suffering from vaginal blood loss could possibly have a malignancy of the endometrium or cervix. General practitioners and gynecologists in the Netherlands have reached agreements and drawn up guidelines on what action to take if such symptoms should arise. The guidelines recommend using ultrasound to examine the endometrium when there is blood loss, and to do a biopsy only if there is a thickening of the endometrium.
Van Doorn’s research showed that the guidelines were applied properly in 70 percent of the patients. In 13 percent of the patients, though, further tests were carried out even though the ultrasound showed a thin endometrium. Because no additional cases of malignancies of the endometrium were detected as a result, the biopsies were unnecessary. In 10 percent of the patients there was thickening of the endometrium and further tests were carried out, but these were unnecessarily extensive.
In Van Doorn’s view, when the situation is favorable (when the endometrium is thin), the gynecologist should carry out no unnecessary tests. And when there is a thickening of the endometrium, the tests should be kept as simple as possible. “In this way tests that are costly and unnecessarily distressing can be avoided,” according to Van Doorn.
Van Doorn received her PhD from Utrecht University on December 13.
For more information please contact: University Medical Center Utrecht, department of internal and external communication, Annette Aarts and Linda Minnen, tel. 088 75 574 83.