TRANSVAGINAL SONOGRAPHY AND HYSTEROSCOPY IN POSTMENOPAUSAL BLEEDING

We compared transvaginal sonography and hysteroscopy with dilatation a nd curettage findings in 45 women with atypical postmenopausal bleedin gs. The histological diagnosis was atrophy in eight (17.8%) women, hor monal effects in 14 (31.1%), endometrial polyp in 19 (42.2%) and adeno carcinoma in four (8.8%). Hysteroscopy detected 16 (78.9%) of the 19 c ases with polyps and two of the four with carcinoma. Sensitivity and s pecificity for endometrial pathology were 86.9% and 91.7% respectively . A polyp was directly diagnosed by transvaginal sonography in 13 (57. 9%) women and an infiltrative endometrial cancer in two. Sensitivity a nd specificity for endometrial pathology were 73.9% and 95.7% respecti vely. All but one case of endometrial pathology were found when the en dometrium (both layers) was thicker than 5 mm. Thus, an endometrial th ickness of greater than or equal to 5 mm had a sensitivity of 95.7%, a specificity of 45.5% and a positive predictive value of 64.7% for end ometrial pathology. This study shows that transvaginal scanning allows detection of an endometrial pathology in the vast majority of cases a nd it may be used as the first diagnostic step in the investigation of women with atypical postmenopausal bleeding.