Hysteroscopy During Menopause

Menopause is characterized by permanent cessation of menstrual periods, and clinically defined after 12 months of complete amenorrhea. It occurs at a median age of 51 alongside with the physiological process of ageing, although it can happen at an earlier age for other medical conditions or after surgery (surgical menopause). Due to reduced estrogen and progesterone levels, reproductive organs undergo progressive atrophy. This reflects also at endometrial level: without the cyclic hormonal actions of the menstrual cycle, the endometrium in menopause becomes atrophic. Nevertheless, many other intrauterine pathologies, such as endometrial or cervical polyps, submucous myomas, and uterine septa, may all be diagnosed during menopause. In addition, the possibility offered by hormone replacement therapy modifies the endometrium, which may proliferate under hormonal stimuli. In this chapter we report common scenarios observed during hysteroscopy in postmenopausal women, with emphasis on indications, diagnostic/therapeutic role of hysteroscopy when performed during menopause, and limits of the technique.