Postmenopausal Vaginal Bleeding During Estrogen Therapy

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Abstract
To the Editor.— The discussion of the management of postmenopausal bleeding during estrogen therapy (225:1539,1973) emphasized the exclusion of endometrial cancer, in these circumstances, by dilatation and curettage (D & C). Uterine bleeding is the most common complication of postmenopausal estrogen therapy, occurring in as many as 30% of patients so treated.1It is also the most significant. Approximately 5% to 8% of the women with bleeding will be found to have endometrial carcinoma.1,2 The traditional manner of endometrial evaluation has been by D & C; however, the histopathologic findings in properly performed endometrial biopsy correlate with those from D & C in more than 90% of cases.3Endometrial biopsy can be done immediately, as an office procedure, thus avoiding hospitalization, anesthesia, and delay in diagnosis. After 5 ml of lidocaine hydrochloride is injected into each uterosacral area (uterosacral block), a very thorough and practically painless biopsy can

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