Causes and Diagnosis of Postmenopausal Bleeding Using Transvaginal Ultrasound and Hysteroscopy: A Prospective Study

Present study was designed and carried out to study aetiology and prevalence of Postmenopausal bleeding (PMB) in Central India as well as to evaluate the efficacy of Trans-vaginalsonography (TVS) and hysteroscopy in diagnosis of different endometrial pathologies in patients with PMB. Menopause is marked by the end of monthly menstruation (also known as a menstrual period or ‘period’) due to loss of ovarian follicular function. This means that the ovaries stop releasing eggs for fertilisation. The regularity and length of the menstrual cycle varies across a woman’s reproductive life span, but the age at which natural menopause occurs is generally between 45 and 55 years for women worldwide. Natural menopause is deemed to have occurred after 12 consecutive months without menstruation for which there is no other obvious physiological or pathological cause and in the absence of clinical intervention. PMB is considered a red flag symptom and warrants further examination and evaluation. TVS can be used reliably to diagnose fibroids, polyps and thickened endometrium. Hysteroscopy is considered “gold standard” for evaluating endometrial cavity. It provides direct visualization of endometrial cavity. It can have both diagnostic as well as operative purpose however, it is not cost effective, an invasive procedure and requires anesthesia and expertise. This prospective study included 82 post-menopausal women with PMB who attended the gynaecological clinic from December, 2019 to December, 2020 at Motherhood hospital, Indore, India after ethical clearance. A detailed history, examination followed by transvaginal sonography was made. Hysteroscopy was then performed, and biopsy was obtained in all patients. Hysteroscopic and sonographic images were then analyzed and conformed with the histopathologic diagnosis. Most common endometrial pathology was atrophic endometrium followed by endometrial polyp and hyperplasia. Endometrial carcinoma was observed in (3.66%) females. Other findings in cases of secretory, proliferative endometrium and endometritis accounted for 6.09%. The diagnostic accuracy of ET by TVS at a cut-off point of 5 mm was 94% with sensitivity 89.3%, specificity 100%, PPV 100% and NPV 88%. The diagnostic accuracy of hysteroscopy was 98% with sensitivity 96.4%, specificity 100%, PPV 100% and NPV 95.7%. Due to its affordability, accessibility, and non-invasive nature, TVS with ET measurement should be used as the initial study in the evaluation of women with suspected endometrial disease who have PMB. Despite the fact that hysteroscopy is more sensitive and specific, it should only be used in low resource settings in cases with unclear endometrial lining, chronic or recurrent bleeding, and endometrial thickness higher than 5 mm regardless of endometrial echotexture.