Title: Diagnostic Accuracy of Transvaginal Ultrasound in Perimenopausal and Postmenopausal Bleeding
Authors: Santhosh Smitha, KM Asokan
DOI: http://dx.doi.org/10.18535/jmscr/v3i10.42
Aim: To study the endometrial pathology in patients with perimenopausal and postmenopausal bleeding by using transvaginal ultrasound, hysteroscopy and histopathology To compare the sonographically measured endometrial thickness and morphology and hysteroscopic finding with histopathologic diagnosis in women with perimenopausal and postmenopausal bleeding Materials and methods: Sample size is 50 and study was conducted between January 2008 and December 2014. Inclusion criteria—perimenopausal women beyond 40 years and postmenopausal women, Exclusion criteria—any use of hormone replacement therapy or progesterone therapy and patients with fibroids and adnexal mass. All patients underwent transvaginal ultrasound (TVS), hysteroscopy and endometrial biopsy in that order. Histopathological report was compared with TVS and hysteroscopic findings Observations: Endometrial thickness measured by transvaginal ultrasound. Thickness above 4 mm is taken as abnormal. Endometrium studied by hysteroscopy and findings compared with transvaginal ultrasound and histopathological findings Conclusions: TVS was complementary to hysteroscopy in the diagnosis of endometrial pathology. A 5 mm cut-off for endometrial thickness in postmenopausal women could reliably be ruled out endometrial pathology. Hysteroscopy was superior to TVS in the detection of focal pathology like polyps. Both TVS and hysteroscopy are complementary diagnostic methods to histopathology and could be accurately used to discriminate between normal and pathologic endometrial conditions in women with postmenopausal and perimenopausal bleeding. Keywords: Perimenopausal bleeding, Postmenopausal bleeding, transvaginal ultrasound, hysteroscopy, histopathological examination, endometrial thickness, endometrial polyp 1. Weber G,Merz E, Bahlmann F, Rosch B. Evaluation of different transvaginal parameters in women with postmenopausal bleeding. Ultrasound Obstet Gynaecol 1998; 12:265-70 2. Buyuk E, Durmusoglu F, Erenus M, KarakocB.Endometrial disease diagnosed by transvaginal ultrasound and dilatation and curettage, ActaObstetGynecol Scand1999;78:419-22 3. Stock RG, Kanbur A. prehysterectomy curettage. ObstetGynecol 1975; 45:537-41 4. Bakour SH, DwarakananthLH.the diagnostic accuracy of ultrasound in predicting endometrial hyperplasia and cancer in postmenopausal bleeding: ActaObstetGynecolScand 2009 ;78:448-51 5. Haller H,Matejsic N, Rukavina B, Krasevic M, Rupcic S, Mozetic Transvaginal sonography and hysteroscopy in women with postmenopausal bleeding. Int J Gynaecol Obstet 1996;54:155-9 6. LoverroG,BettochiS,CormioG,NicolardiV,GrecoP,Vimercarti A et al.Transvaginal sonography and hysteroscopy in postmenopausal uterine bleeding, Maturitas 1999;33:139-44 7. Smith Bindman R, Kerlikowske K, Feldstein VA etal.Endovaginal ultrasound to exclude endometrial cancer and other abnormalities. J Am Med Assocn 1998;280:1510-17 8. Granberg S, Wiklan M. Endometrial thickness as measured by transvaginal ultrsonography for identifying endometrial abnormality.Am J ObstetGynecol 2011;164:47-52 9. Saidi MH, Bigrigg MA, Browning JJ, Brookes ST, Smith PA.A randomized controlled trial comparing transvaginal ultrasound outpatient hysteroscopy and endometrial biopsy with inpatient hysteroscopy and curettage. Br J ObstetGynecol 1999;106:1259-64 10. Haller H, O’Connor H,BaskettT,Davies A ,Mohammed H, Magos AL. Hysteroscopy in women with uterine bleeding on hormone replacement therapy:a comparison with postmenopausal bleeding. FertSteril 1996;65:1145-50 11. Souza R, Serden SP: Hysteroscopic findings after unsuccessful dilatation and curettage for abnormal uterine bleeding.Am J ObstetGynecol 1998;158: 1354-57 Abstract
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