Ultrasound assessment of the endometrium in healthy, asymptomatic early post-menopausal women: saline infusion sonohysterography versus transvaginal ultrasound

Objective To exclude pre-existing endometrial pathology in asymptomatic ear ly post-menopausal women before starting hormone replacement therapy by tra nsvaginal ultrasound (TVS) and saline infusion sonohysterography (SIS). Methods In a cross-sectional study, 148 healthy women (mean age, 51.1 years ; range, 46-59 years) underwent ultrasound evaluation of the endometrium be fore participation in a clinical trial. TVS was used to measure double-laye r endometrial thickness. SIS was performed at the same visit to measure ant erior and posterior single-layer endometrial thickness, and to identify end ometrial abnormalities when present. Ultrasound results were defined as inf ormative if the endometrium could be adequately visualized. Findings on TVS s were defined as abnormal if a double-layer endometrial measurement > 5.0 mm was obtained. Findings on SIS were defined as abnormal if one or both si ngle layers of the endometrium measured > 2.5 mm, or if focal endometrial t hickening or a polyp was present. Results Of the 148 eligible women, informative TVS results were obtained fr om 134 women, SIS results from 133 women and both procedures combined from 119 women. TVS scans gave abnormal results in 8.2% of women (11 of 134) and SIS gave abnormal results in 36.8% of women (49 of 133). Of the 14 women w ith a noninformative TVS, eight had abnormal SIS results. Of the 15 women w ith a non-informative SIS, three had abnormal TVS results. In the 119 women with both informative TVS and SIS, abnormal TVS scans were found in 6.7% o f women (eight of 119) and abnormal SIS in 34.5% of women (41 of 119). AN e ight women with abnormal TVS had an abnormal SIS, whereas 29.7% (33 of 121) of the women with a normal TVS had an abnormal SIS. Conclusions Ultrasound evaluation demonstrated endometrial abnormalities in 34.5% (41 of 119) of asymptomatic post-menopausal women. SIS is more accur ate than TVS in the detection of endometrial abnormalities.