Value of hysteroscopy and transvaginal sonography in endometrial pathology in bleeding and nonbleeding postmenopausal women

Abstract

The evaluation of the endometrium has evolved with varying amounts of evidence and often little validation of what has dominated the clinical practice. Aims and objectives: To study the value of hysteroscopy and transvaginal sonography (TVS) in endometrial pathology in bleeding and nonbleeding postmenopausal women. Materials and methods: A prospective study was conducted in the Department of Obstetrics and Gynecology, Subharti Medical College, Meerut, Uttar Pradesh, India. A total of 280 menopausal patients with or without postmenopausal bleeding (PMB) were included in our study. Out of 280 women, 204 women who had PMB were put in group I, and 76 women with no PMB were put in group II after exclusion criteria were met. Results: In our study, majority (46.6%) had polyp, 9.47% had atrophic endometrium, 29.29% had normal endometrium, 2.4% women had endometrial hyperplasia, and 2.1% had endometrial carcinoma on histopathology, which positively correlated with hysteroscopy. For diagnosing any pathology, hysteroscopy had better specificity (p < 0.001), although the two methods did not differ with regard to sensitivity (p = 0.188). For the diagnosis of polyps of any size, hysteroscopy had better sensitivity (p < 0.001); however, specificities did not differ (p = 1.0). Conclusion: There seems to be great confusion about appropriate evaluation in symptomatic menopausal women using TVS and/or hysteroscopy as well as how to proceed with incidental findings in asymptomatic postmenopausal women. A significant number of patients without PMB had abnormal findings on hysteroscopy like polyps. However, none had malignancy in this group.