Utilizing routine sonohysterography to detect intrauterine pathology before initiating hormone replacement therapy

Objective: To assess the utility of performing routine sonohysterography in conjunction with endometrial thickness measurement for detecting intrauter ine pathology in asymptomatic postmenopausal women. Design: Asymptomatic postmenopausal women (n = 60, mean age 52.7 +/- 4.5 ye ars, amenorrhea greater than or equal to 6 months, follicle stimulating hor mone greater than or equal to 40 mIU/mL) were evaluated with sonohysterogra phy followed by endometrial biopsy before initiating hormone replacement th erapy. Results: Hyperplasia was detected in 5 of 22 (22.7%) patients with endometr ial thickness of >5 mm and in 0 of 38 (0.0%) patients with endometrial thic kness of less than or equal to 5 mm. When sonohysterography was performed, intracavitary pathology was discovered in 14 of 38 (36.8%) patients with en dometrial thickness of less than or equal to 5 mm (10 polyps, three submuco sal myomas, and one septate uterus) and 14 of 22 (63.6%) patients with endo metrial thickness of >5 mm (nine polyps, four submucosal myomas, and one As herman's syndrome). Conclusions: Endometrial thickness of 15 mm excludes hyperplasia but does n ot eliminate other intrauterine pathology that may be discovered by sonohys terography. (Menopause 1999;6:68-70 (C) 1999, The North American Menopause Society.).