Transvaginal sonography and hysteroscopy in women with postmenopausal bleeding

Objective: To make a prospective comparison between endometrial thickness determined by transvaginal sonography (TVS) and hysteroscopic findings in women with postmenopausal bleeding with histologic findings obtained by dilatation and curettage (D&C). Methods: Eighty-one patients who had not received hormonal replacement therapy were scanned by transvaginal probe, and double-layer endometrial thickness was measured 1 day before hysteroscopy and D&C. Results: The histologic diagnosis was atrophy in 12 cases, irregular proliferative changes in 21, endometrial polyps in 16, hyperplasia in 16 and endometrial carcinoma in 16. TVS detected 46 of 48 pathologic conditions, including all cases of endometrial carcinoma if the endometrial thickness (both layers) was greater than or equal to 5 mm (sensitivity 95.8%, specificity 45.5%). Hysteroscopy also detected the endometrial pathology in 46 of 48 cases but with a higher specificity (sensitivity 95.3%, specificity 93.9%). Conclusion: TVS and hysteroscopy are complementary diagnostic methods and could be accurately used to discriminate between normal and pathologic conditions in patients with postmenopausal bleeding.