SONOHYSTEROGRAPHY FOR DISTINGUISHING ENDOMETRIAL THICKENING FROM ENDOMETRIAL POLYPS IN POSTMENOPAUSAL BLEEDING

Sonohysterography, or sonographic uterine cavity visualization by uter ine cavity distension, may help to distinguish true endometrial thicke ning from other intracavitary pathological conditions, assuming the sa me sonographic appearance. We examined 15 women with a thickened endom etrium (range 10-25 mm) in sonography performed for postmenopausal ble eding. Sonohysterography revealed a polypoid structure in seven women, a normal uterine cavity in four women, and a thickened endometrium in four women. All the women underwent hysteroscopic evaluation of the u terine cavity. Hysteroscopy confirmed the sonohysterographic findings in 14 women (93.3%). Hysteroscopic resection of the polypoid structure was performed while the other patients underwent diagnostic curettage . Histological examination of the seven polypoid structures revealed b enign endometrial polyps in six patients, and one pedunculated submuco us fibroid. In the patients undergoing diagnostic curettage, histologi cal examination revealed three cases of glandular hyperplasia, one of cystic (atrophic) hyperplasia, and one of papillary endometrial adenoc arcinoma. Two cases were inadequate for diagnosis. The advantage of so nohysterography in distinguishing endometrial thickening from intracav itary polyps or fibroids was clearly demonstrated. This technique can help in tailoring the correct treatment in various conditions presenti ng as postmenopausal bleeding.