TRANSVAGINAL ULTRASONOGRAPHY FOR IDENTIFYING ENDOMETRIAL PATHOLOGY INPOSTMENOPAUSAL WOMEN

The objective of this study was to evaluate the usefulness of transvag inal ultrasonography in postmenopausal women with a clinical indicatio n for a dilatation and curettage (D&C). Of the 167 postmenopausal wome n included in the study, 88% were referred for a D&C because of vagina l bleeding and 12% of the women had other clinical indications such as myomas, gynecological pain or suspected gynecological tumors. Hormone replacement therapy (HRT) was used by 37% of the women. The women wer e examined with transvaginal ultrasonography before the D&C. The endom etrial thickness and texture were used as indicators of endometrial ab normalities. The ultrasonographical findings were related to the histo logical diagnosis obtained from the D&C. Histologically, 31% of the wo men had an atrophic endometrium and the corresponding ultrasonographic ally mean endometrial thickness was 4.6 mm (range 0-14 mm). Endometria l cancer was histologically found in 10% of the women and the endometr ial thickness of the malignant endometrium, measured by ultrasonograph y, was 13.9 mm (range 6-31 mm). All the malignancies were found in the group of women with vaginal bleeding, but only one was in the group o f women on HRT. Histologically, endometrial hyperplasia was found in 6 .5% of the women and endometrial polyps in 8.5% after the D&Cs. In the se postmenopausal women it was demonstrated that if the endometrium wa s < 6 mm thick, no endometrial cancer was found at histopathological i nvestigation. By using a cut-off point of 6 mm of ultrasonographically measured endometrial thickness for identification of endometrial path ology in our study, at least 50% of the D&Cs could be spared.