Published: 2022-02-25

Comparative study of hysteroscopy with ultrasonography and its correlation with histopathology in cases of abnormal uterine bleeding in perimenipausal women

Ayushi Upadhyay, Mamta Tyagi, Smriti Gupta, Rani Bansal, Yamini Varma


Background: The aim was to compare the diagnostic efficacy of ultrasonography (USG) and hysteroscopy in detecting uterine abnormalities in abnormal uterine bleeding (AUB) by correlating the results with histopathological examination.

Methods: This prospective study was conducted among women attending gynecological OPD of Subharti medical college, Meerut over a period of two years from October 2019 to August 2021. A total of 100 perimenopasual women with AUB attending obstetrics and gynaecology OPD were included in this study. All patients underwent transvaginal scan to note down the endometrial thickness and to rule out uterine and adnexal pathology. All the patients underwent diagnostic hysteroscopy, followed by a biopsy of the endometrium using a curette. The endometrium was sent to the pathologist. Findings of these diagnostic modalities then correlated.

Results: Out of 100 women, USG detected that 54 patients (54%) had no pathology and 46 patients (46%) had abnormal findings, out of which maximum patients, 29 patients (63.04%) had endometrial hyperplasia. According to hysteroscopy, 46 patients (46%) had normal hysteroscopic findings while 54 patients (54%) had abnormal findings of which maximum were 18 patients (33.33%) who had endometrial hyperplasia. Histopathology findings revealed that 47 patients (47%) had normal findings and 53 patients (53%) had abnormal findings out of which maximum patients 20 (37.7%) had endometrial hyperplasia. In our study of 100 women with AUB, on USG only 1 patient had endometrial malignancy and the same was reported by hysteroscopy and histopathology.

Conclusions: In our study hysteroscopy proved to be highly sensitive and specific considering histopathology as gold standard. Ultrasonography has good sensitivity and specificity but less as compared to hysteroscopy.


Hysteroscopy, Ultrasonography, Endometrial biopsy, Histopathology

Full Text:



Jaiswar SR, Sachan R, Srivastava PK. A comparative diagnostic evaluation of hysteroscopy, transvaginal Ultrasonography and histopathological examination in cases of abnormal uterine bleeding. Obstet Gynecol India. 2006;56:240-3.

O’Connor VM. Heavy menstrual loss. Part 1: is it really heavy loss? Med Today. 2003;4(4):51-9.

Viols GA, Lefebvre G, Graves GR. Guidelines for the management of abnormal uterine bleeding. J Obstet Gynaecol Can. 2001;23(8):704-9.

Veena BT, Shivalingaiah N. Role of transvaginal sonography and diagnostic hysteroscopy in abnormal uterine bleeding. J Clin Diagn Res. 2014;8(12):6-8.

Hunter DC, McClure N. Abnormal uterine bleeding: an evaluation endometrial biopsy, vaginal ultrasound and out patient hysteroscopy. Ulster Med J. 2001;70(1):25-30.

Dangal G. A study of endometrium of patients with abnormal uterine bleeding at Chitwan valley. Kathmandu Univer Med J. 2003;1(2):110-2.

Jain M, Kanhere A, Jain AK. Abnormal uterine bleeding: a critical analysis of two diagnostic methods. Int J Reprod Contracept Obstet Gynecol. 2014;3(1):48-53.

Goyal BK, Gaur I, Sharma S, Saha A, Das NK. Transvaginal sonography versus hysteroscopy in evaluation of abnormal uterine bleeding. Med J Armed Forces India. 2015;71(2):120-5.

Dubinsky TJ, Parvey HR, Maklad N. The role of transvaginal sonography and endometrial biopsy in the evaluation of peri and postmenopausal bleeding. Am J Roentgenol. 1997;169(1):145-9.

Breitkopf D, Frederickson R, Snyder R. Detection of benign endometrial masses by endometrial stripe measurement in premenopausal women. Obstet Gynecol. 2004;104(1):120-5.

Sharma J, Tiwari S. Hysteroscopy in abnormal uterine bleeding vs ultrasonography and histopathology report in perimenopausal and postmenopausal women. Women. 2016;55:203-9.

Kotdawala P, Kotdawala S, Nagar N. Evaluation of endometrium in perimenopausal abnormal uterine bleeding. J Midlife Health. 2013;4(1):16-21.

Word B, Gravlee LC, Wideman GL. The fallacy of simple uterine curettage. Obstet Gynec. 1958;12(6):642-8.

Bree RL, Bowerman RA, Bohm-Velez M, Benson CB, Doubilet PM, DeDreu S, et al. US evaluation of the uterus in patients with postmenopausal bleeding: a positive effect on diagnostic decision making. Radiol. 2000;216(1):260-4.

Talukdar B, Mahela S. Abnormal uterine bleeding in perimenopausal women: correlation with sonographic findings and histopathological examination of hysterectomy specimens. J Midlife Health. 2016;7(2):73-7.

Patil CS. A study of clinical correlation with histopathological diagnosis of abnormal uterine bleeding MedPulse. Int Med J. 2016;3(7):697-9.

Kaur H, Goyal L, Kaur P. To validate the use of trans vaginal sonography: a noninvasive tool as a screening method for patients with postmenopausal bleeding. Int J Gynecol Obstet. 2012;6(4):1-5.

Joshi SK. Atypical uterine bleeding-Histopathological audit of endometrium A study of 638 cases. Al Ameen J Med Sci. 2013;6(1):21-8.

Gadge A, Acharya N, Shukla S, Phatak S. Comparative study of transvaginal sonography and hysteroscopy for the detection of endometrial lesions in women in abnormal uterine bleeding in perimenopausal age group. J South Asian Feder Obst Gynae. 2018;10(3):155-60.

Audimulapu S, Sudeepti M. A comparative diagnostic evaluation of hysteroscopy, transvaginal ultrasonography and histopathological examination in 50 cases of abnormal uterine bleeding. IAIM. 2017;4(8):1-11.

Garg P, Yadav S. Comparison of transvaginal ultrasonography and hysteroscopy in the evaluation of peri and postmenopausal bleeding. J Evolution Med Dent Sci. 2016;5(21):1133-6.

Sousa R, Silvestre M, Almeida E. Transvaginal ultrasonography and hysteroscopy in postmenopausal bleeding: a prospective study. Acta Obstet Gynaecol Scand. 2001;80(9):856-62.

Haller H, Matecjcic N, Rukavina B. Transvaginal sonography and hysteroscopy in women with postmenopausal bleeding. Int J Gynaecol Obstet. 1996;54(2):155-9.

Taipale P, Tarjanne H, Heinonen UM. The diagnostic value of transvaginal sonography in the diagnosis of endometrial malignancy in women with peri- and postmenopausal bleeding. Acta Obstetricia et Gynecologica Scsandinavica. 1994;73(10):819-23.

Vitner D, Filmer S, Goldstein I, Khatib N, Weiner Z. A comparison between ultrasonography and hysteroscopy in the diagnosis of uterine pathology. European J Obstet Gynecol Reproductive Biol. 2013;171(1):143-5.