Transvaginal sonography for the evaluation of postmenopausal bleeding

To evaluate the effectiveness of transvaginal sonography in assessing the endometrial thickness in patients with postmenopausal uterine bleeding. This will be studied in relation to the histopathological results of the endometrial biopsy, so as to detect its accuracy to diagnose endometrial cancer without the need for dilatation and curettage. A total of 123 women with ages varying from 50 to 65 years, who were diagnosed with /or had postmenopausal bleeding. Their history was taken and a general examination was done. However, patients who had the risk of having endometrial carcinoma or those undertaking hormonal therapy were excluded from the study. All patients were examined with the transvaginal ultrasound to measure the endometrial thickness, and scheduled for endometrial sampling by dilatation and curettage, then compare the histological findings with the sonographic results. The study was based on a cut-off value of endometrial thickness 5mm or less to exclude malignancy, and the patients were classified according to endometrial measurement into 5.6-19 and more than 20mm. Seventy two patients had atrophic endometrium; endometrial thickness was 1.7-3mm, while 37 patients with the thickness of 6.3-8.1mm had uterine polyps. Simple hyperplasia was found in 9 patients and the endometrial thickness was 10.1-13mm, and in four patients complex hyperplasia was found with an endometrial thickness of 14-17.5mm. One patient had endometrial carcinoma with an endometrial thickness of 25.3mm. Transvaginal sonography investigation for postmenopausal bleeding may provide useful information for patients under high risks of endometrial abnormalities. When using such a technique for measuring the endometrial thickness in women with postmenopausal bleeding, it is reasonable not to perform a dilatation and curettage if the endometrial thickness is < 5 mm

Molar pregnancy in A 53-year-old patient

We report a case of hydatidiform mole in a 53-years-old patient referred to Gynecology and Obstetric Department at King Hussein Medical Center with irregular vaginal bleeding; she was found to have a mole and underwent total abdominal hysterectomy and bilateral salpingoophorectomy

Comparative study of transvaginal hysterosonography and biopsy for the evaluation of post-menopausal bleeding

The aim of this prospective study was to evaluate transvaginal hysterosonography [TVHS] in post-menopausal bleeding [PMB] as an alternative to endometrial biopsy. The study was conducted at the Zarka Military Hospital, Amman, Jordan, over a one-year period from 1996 to 1997. Patients and The study comprised 98 women presenting with post-menopausal bleeding who had been listed for diagnostic dilatation and curettage. Transvaginal sonography [TVS] and transvaginal hysterosonography were performed one week before operation. The mean age of the women was 57 years, and all of them had had their menopause for at least six months. Sixty-one women [62%] demonstrated endometrial thickness of more than 5 mm by transvaginal sonography. All the women had transvaginal hysterosonography, except seven on whom hysterosonography could not be performed for technical reasons and who had to be excluded from the study, leaving a total of 54 women. TVS confirmed the presence of endoluminal mass in 30 of 54 women [60%]. Twenty-two of the 30 endoluminal mass cases were pedunculated while eight were sessile. Sixteen of the pedunculated cases were endometrial polyps while the remaining six were fibroid polyps. Five of the sessile cases were fibroid, two were endometrial hyperplasia, and the last one endometrial carcinoma. The other 44 out of the 98 patients also underwent transvaginal hysterosonography. No pathology could be detected in these patients, but they were noted to have atrophic endometrium after dilatation and curettage. The combination of transvaginal sonography and transvaginal hysterosonography is both sensitive and specific with regard to detecting and excluding endoluminal masses as the cause of post-menopausal bleeding. Diagnostic dilatation and curettage fails to detect a large percentage of some lesions, so TVS in combination with TVHS should be considered as the initial examination in the evaluation of all women with post-menopausal bleeding