THE ROLE OF TRANSVAGINAL ULTRASONOGRAPHY AND OUTPATIENT DIAGNOSTIC HYSTEROSCOPY IN THE EVALUATION OF PATIENTS WITH MENORRHAGIA

To verify the reliability of transvaginal ultrasonography in diagnosin g intrauterine disease and in evaluating the operability of submucous myomas and to determine the feasibility, acceptability and validity of hysteroscopy for menorrhagia, we performed a prospective 5 year study on 793 women of mean age +/- SD of 41.5 +/- 7.8 years, All the patien ts referred for excessive menstrual bleeding with uterine volume (12 w eek pregnancy who underwent complete physical examination, transvagina l ultrasonography and outpatient hysteroscopy with endometrial biopsy were included in the study, Outpatient hysteroscopy was not completed due to intolerance or was unsatisfactory due to excessive bleeding in 23 cases (2.9%), Only 28 women (3.5%) declared they mould have refused the procedure had they imagined the pain involved, One case of pelvic infection was observed, Compared with hysteroscopy, transvaginal ultr asonography had 96% sensitivity, 86% specificity, 91% positive predict ive value and 94% negative predictive value in the diagnosis of intrau terine abnormality, The sensitivity, specificity, positive and negativ e predictive values of ultrasonography in identifying submucous myomas operable hysteroscopically (intramural extension <50%) were respectiv ely 80, 69, 83 and 65% with a k index of agreement between ultrasonogr aphy and hysteroscopy of 0.48, Thus, considering the good specificity and high negative predictive value, transvaginal ultrasonography may b e suggested as the initial investigation in menorrhagic patients, limi ting hysteroscopy to cases with positive or doubtful sonographic findi ngs.