Use of hysterosonography in women with abnormal postmenopausal bleeding

Purpose of investigation. Hysterosonography (HS) allows evaluation of the e ndometrial cavity by endouterine administration of sterile physiologic solu tion. We aimed to identify the rule of HS and transvaginal ultrasonography (TU) in postmenopausal women with unexplained bleeding in order to avoid fu rther invasive investigation for patients with atrophic endometrium, and to obtain significant information on intracavitary focal lesions. Methods: Eighty postmenopausal women with unexplained metrorrhage underwent both TU and HS. They were subsequently referred for hysteroscopy or dilata tion and curettage, and histology was obtained. Results. The sensibility of TU was comparable with that of HS (90% vs 93%). However, the specificity of TU was only 30%. Combined use of TU and HS rai sed sensibility and specificity to 95.9% and 96.7%, respectively. Conclusion. HS is superior to TU in the diagnosis of focal lesions because the uterine cavity, lesion volume and margins, and associated diffuse endom etrial alterations are adequately depicted. HS is particularly valuable wit h benign focal lesions associated with atrophic endometrium. as in patients under tamoxifen in whom TU fails to detect the: uterine cavity.