Heavy periods and bleeding between periods in pre-menopausal women: is it OK to wait and see without biopsy?

We will discuss “Premenopausal abnormal uterine bleeding and risk of endometrial cancer” by Pennant and co-workers from 30 November 2016 for 7 days.

*This paper is open accesshttp://bit.ly/2fEA3TV.

We are now on LinkedIn too: http://linkd.in/1BVrpad (simply ask to join)!

Start date: 30 November 2016 (the discussion will continue for 7 days between 30 November – 7 December 2016)

First hosted discussion session(s) on Twitter starts at GMT+1 (British Summer Time) 8pm on 30 November 2016 (using hashtag #BlueJC)

Host: @BlueJCHost

Platforms: Twitter, Facebook and LinkedIn 

BJOG_BlueJC_160x600WebBanner_Mar15_(reoriented)_3The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues.

The discussion points are attached below (quoted from the published Journal Club guide)

 

Scenario

A 32-year-old nulliparous woman presented to your clinic with bleeding in between her periods for the past 6 months.

Her periods had been regular prior to her new symptom. She had an up-to-date and normal smear, and recent tests for genital tract infections were negative. She had no other medical history.

How would you manage this woman?

 

Description of research

Participants Studies reporting rates of endometrial carcinoma and/or atypical hyperplasia of women with pre-menopausal abnormal uterine bleeding
Intervention Endometrial biopsy and histological analysis
Comparison Prevalence of endometrial malignancy
Outcomes Risk of endometrial cancer or atypical hyperplasia
Study design Studies reporting rates of endometrial carcinoma and/or atypical hyperplasia of women with pre-menopausal abnormal uterine bleeding
Authors’ conclusion The combined risk of endometrial cancer is low (0.34%; 95% CI 0.28 to 0.42%, n=28,162; 96 cases)

Discussion Points

  • Which additional factors would you consider when you manage the woman in the above scenario?
  • How do you currently manage the women in the clinical scenario?
  • What is the best way to determine the prevalence of a disease in different subgroups of the population?
  • What are the strengths and weaknesses of this meta-analysis for this research question? (see suggested reading)
  • In particular, do you have additional comments with regards to the search strategy and selection criteria?
  • What is the prevalence (with confidence intervals) of endometrial cancer and atypical hyperplasia identified in this study?
  • Are the results of the existing study consistent with published guidelines?

Suggested reading

Scottish Intercollegiate Guidelines Network. Critical Appraisal: notes and checklists. Methodology checklist 1: Systematic reviews and meta-analyses. http://www.sign.ac.uk/methodology/checklists.html (Last access 20 July 2016)

For those who want to understand hashtags, this may be a useful guide. For an introduction to #BlueJC, please refer to BJOG 2013;120:657–60. Follow @BlueJCHostthis blog and our Facebook page to receive news about #BlueJC.