Correlation between transvaginal ultrasound measured endometrial thickness and histopathological findings in black women with postmenopausal bleeding

OBJECTIVES: To determine whether a postmenopausal endometrial thickness of 5 mm excludes endometrial pathology in the black woman with postmenopausal bleeding. METHODS: Seventy-five black women with postmenopausal bleeding participated in this prospective study between August 1, 1998 and July 31, 1999. The patients had a questionnaire administered, which sought to obtain general information about their age, gynaecological, obstetric and social history. The patients then had a transvaginal ultrasound with double layer measurement of their endometrium; this was followed by hysteroscopy and suction curettage. The curettings were sent for histopathological analysis. The local hospital ethics comittee approved the study. RESULTS: Correlation between the endometrial thickness and endometrial pathology was not very reliable. Fifty per cent of the patients with endometrial cancer had an endometrial thickness of 3-4 mm. Seventy per cent of the women with endometrial thickness of greater than 5 mm had benign pathology. Additionally, the following characteristics were found to be more strongly associated with endometrial cancer: age over 65 years (p = 0.015; relative risk (rr) 1.406), 5 or more years since menopause (p = 0.0176; rr = 1.295) and primary infertility (p = 0.0124; rr = 0.438). CONCLUSION: A double layer endometrial thickness of less than 5 mm, as measured by transvaginal ultrasound, does not exclude endometrial cancer as a cause of postemnopausal bleeding in the black female. A black, postmenopausal female with transvaginal ultrasound measured double layer endometrial thickness of 3 mm or greater and postmenopausal bleeding needs further investigation. Age, time since menopause, endometrial thickness and infertility are strongly associated with endometrial cancer in postmenopausal black women.(Au)

Correlation between histopathology evaluation by curettage and diagnostic hysteroscopy in patients with abnormal uterine bleeding

Diagnostic hysteroscopy was performed on a total of 54 patients with abnormal uterine bleeding, comprising 42 premenopausal and 12 postmenopausal patients. The commonest finding on hysteroscopy in the premenopausal patients was submucous fibroid accounting for 28.6 percent of cases, while endometrial polyp was the commonest finding in postmenopausal patients constituting 33.3 percent of cases. After excluding submucous fibroids, the concordance rate between hysteroscopy and histopathology was found to be 74 percent, even in the absence of targeted biopsy, thus confirming is diagnostic accuracy. A sensitivity of 87 percent and a specificity of 85 percent were obtained.(AU)

Successful pregnancy outcome after hysteroscopic adhesiolysis in Asherman's syndrome

Asherman's syndrome is an uncommon finding at hysterosalpingography for infertility. Modern day management entails hysteroscopic confirmation and adhesiolysis. We present one such case of a young woman who had secondary infertility after dilatation and curettage, and who was diagnosed and treated with a successful outcome.(AU)

Hysteroscopic assessment of abnormal uterine bleeding in users of the intrauterine contraceptive device

Sixty users of the IUD who complained of abnormal menstural blood loss were evaluated by hysteroscopy, and the findings were compared with a matched group who had this investigation for "missing strings". Submucous fibroids and endometritis were more frequent in the study group whereas malposition of the IUD was commoner in the controls (p<0.05) (AU)

Diagnostic hysteroscopy

Diagnostic hysteroscopy was performed on 100 patients. The most frequent indication was abnormal uterine bleeding. In premenopausal women, submucous fibroids were the main findings and in postmenopausal women, 59 per cent had an atrophic endometrium. Precise localization of the missing intrauterine contraceptive devices was achieved in all cases. Hysteroscopy improved diagnostic accuracy and reduced the need for blind curretage. (AU)