THE ROLE OF TRANSVAGINAL SONOGRAPHY AND ENDOMETRIAL BIOPSY IN THE EVALUATION OF PERIMENOPAUSAL AND POSTMENOPAUSAL BLEEDING

OBJECTIVE. The number of women seeking medical attention for peri- and postmenopausal bleeding (PMB) has been increasing. Determining the ca use of PMB is essential in planning appropriate therapy. In these wome n, transvaginal sonography (TVS) is a sensitive means for diagnosing t he causes of such bleeding, yet endometrial biopsy (EMB) is still pref erred as the first diagnostic test. We prospectively compared TVS with aspiration biopsies of the endometrium in the examination of women wi th PMB. SUBJECTS AND METHODS, Between mid April 1994 and December 1995 , 329 consecutive perimenopausal women underwent EMB. Of these EMBs 30 2 had negative results. We prospectively obtained TVS in 259 of these 302 women within 1 month of EMB (range, 10 days to 2 months) when the results of biopsy were negative. Forty-three patients were lost to fol low-up. In 59 women who had endometrial thickening greater than 5 mm, dilatation and curettage, hysteroscopy, or hysterectomy was performed. Ninety-four of the 130 women who were found at TVS to have fibromyoma ta or diffusely enlarged uteri underwent hysterectomy for pathologic c onfirmation. The remaining 36 women with fibromyomata or diffusely enl arged uteri had no pathologic confirmation of their TVS findings. Twen ty-one of 64 women with endometria thinner than 5 mm underwent dilatat ion and curettage, and 43 of these women were lost to follow-up. RESUL TS. In 259 patients who underwent TVS, 57 patients who had an endometr ium thicker than 5 mm and an endoluminal mass on hysterosonography had false-negative results on aspiration biopsies. Of the 18 patients who had malignancies in this series, 12 had false-negative results on bio psies. In the 94 patients with an enlarged uterus and negative EMB res ults who underwent hysterectomy, we found 87 with fibroids, three with adenomyosis, and four with sarcomas. Of the 64 women with endometria thinner than 5 mm seen on TVS, 21 had negative results from dilatation and curettage. CONCLUSION, EMB alone is not sufficient for screening women for PMB. TVS appears to be more sensitive than is EMB for the de tection of abnormalities, particularly those outside the endometrium. For these reasons, TVS should be the initial screening test when exami ning women with PMB.