Prospective study of role of transvaginal sonography in postmenopausal bleeding and its histopathological correlation: a prospective study from a tertiary care hospital of Rajasthan

Authors

  • Narendra Joshi Department of Obstetrics and Gynecology, RNT Medical College, Udaipur, Rajasthan, India
  • Kalpesh Patel Department of Obstetrics and Gynecology, RNT Medical College, Udaipur, Rajasthan, India
  • Bhawani Shankar Sharma Department of Obstetrics and Gynecology, RNT Medical College, Udaipur, Rajasthan, India
  • Neeraj Choudhary Department of Obstetrics and Gynecology, RNT Medical College, Udaipur, Rajasthan, India
  • Balveer Jakhar Department of Obstetrics and Gynecology, RNT Medical College, Udaipur, Rajasthan, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20250868

Keywords:

Postmenopausal bleeding, Atrophic and thickened endometria, Transvaginal sonography

Abstract

Postmenopausal bleeding is vaginal bleeding that occurring after one years of menopause. When periods have stopped for more than one years in women who are generally over than 45 years old and it is common condition in postmenopausal women, it can be the presenting symptom of endometrial cancer. Aim of study is to assess endometrial thickness by vaginal sonography and correlate it with the cytological pattern evaluated by endometrial sampling and histopathological typing of the endometrium.

Methods: This is a prospective observational study conducted in department of obstetrics and gynaecology at R.N.T. Medical college Udaipur from January 2022 to October 2024.  Total 100 women with postmenopausal bleeding who attended the Gynaecology outpatient department were screened for this study. Transvaginal ultrasound examination was carried out to calculate endometrial thickness.

Results: This study depicts atrophic and thickened endometria were considered normal findings which was 73 of 100 (73%). The following were considered abnormal seen in 27% (27/100).Endometrial hyperplasia was seen in 15 of 100 women (15%), endometrial carcinoma in 7 women (7%) and endometrial polyp in 5 women (5%). 3/4th (71%) patients had endometrium findings are non-malignant e.g., atrophic endometrium (46%), proliferative endometrium (19%), secretory endometrium (09%). While29% cases in endometrium findings e.g. hyperplasia (17%), polyp (6%), carcinoma (6%).

Conclusions: Transvaginal sonography is safe, simple, non-invasive and cost effective in the diagnosis of endometrial disease. Evaluation of PMB at the earliest is essential for diagnosing endometrial status for early intervention. Role of endometrial thickness cannot be undermined for detecting patients at high risk especially with co-morbid conditions. endometrial thickness of less than 5 mm, most of the reports were benign on HPR and those with endometrial thickness of 10mm or more had mostly malignant findings. So we conclude that with increasing endometrial thickness, the risk of malignancy increases.

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References

Hoffman BL, Schorge JO, Bradshaw KD, Halvorson LM, Schaffer JI, Cotron MM. Menopausal Transition. In: Williams Gynaecology (4th Ed.), McGraw Hill Education, 2018: 471.

In: Berek JS, Rinehart RD, Adashi EY editors. Berek and Novak’s Gynecology. 14th ed. Lippincott Williams and Wilkins; 2012: 1234-1255.

Kumar P, Malhotra N. Menopause. In: Jeffcoat’s Principles of Gynecology, 7th ed. Jaypee Brothers Medical Publishers (P) Ltd. 2008: 613.

Van Doorn HC, Opmeer BC, Duk MJ, Kruitwagen RF, Dijkhuizen FP. The relation between age, time since menopause, and endometrial cancer in women with postmenopausal bleeding. International J Gynecol Cancer. 2007;17(5):1118-23. DOI: https://doi.org/10.1111/j.1525-1438.2007.00925.x

Adams HIllard PJ. Benign diseases of the female reproductive tract. In: Berek JS, Rinehart RD, Adashi EY editors. Berek and Novak’s Gynecology. 14th ed. Lippincott Williams and Wilkins; 2007: 490-91.

Bharadwaj JA, Kendurkar SM, Vaidya PR. Transvaginal ultrasonography and endometrial biopsy as a diagnostic schema for endometrial cancer and hyperplasia. Gynecol Obstet Invest. 2005;59(3):149-54. DOI: https://doi.org/10.1159/000083089

Novak E. Berek & Novak's gynecology. Lippincott Williams & Wilkins. 2007.

Sapre S, Thakur R. Lifestyle and dietary factors determine age at natural menopause. J mid-life Health. 2014;5(1):3-5. DOI: https://doi.org/10.4103/0976-7800.127779

Ferlay J. Cancer incidence, mortality and prevalence worldwide. GLOBOCAN2002. 2004.

Jemal A, Siegel R, Ward E. Cancer statistics, 2006, CA cancer J Clin. 2006;56:106-30. DOI: https://doi.org/10.3322/canjclin.56.2.106

Bray F. Endometrial cancer incidence trends in Europe: underlying determinants and prospects for prevention. Cancer Epidemiol Biomarkers Prev, 2005;14(5):1132-42. DOI: https://doi.org/10.1158/1055-9965.EPI-04-0871

Ghirardini G, Montanari R, Gualerzi C. Vaginosonography in primary prevention of endometrial oncological pathology. Clin Exp Obstet Gynecol. 1991;18:149-51.

Clarke MA, Long BJ, Del Mar Morillo A, Arbyn M, Bakkum-Gamez JN, Wentzensen N. Association of Endometrial Cancer Risk With Postmenopausal Bleeding in Women: A Systematic Review and Meta-analysis. JAMA Intern Med. 2018;178(9):1210-22. DOI: https://doi.org/10.1001/jamainternmed.2018.2820

Gull B, Karlsson B, Milsom I and Granberg S. Can ultrasound replace dilatation and curettage. A longitudinal evaluation of postmenopausal bleeding and transvaginal sonographic measurement of the endometrium as predictors of endometrial cancer. Am J Obstet Gynecol 2003;188(2):401-8. DOI: https://doi.org/10.1067/mob.2003.154

Garuti G, Samhruni I, Cellani F. Hysteroscopy and transvaginal ultrasonography in postmenopausal women with uterine bleeding. Int J Gnecol Obstet. 1999;65(1):25–33. DOI: https://doi.org/10.1016/S0020-7292(98)00224-0

Tinelli R, Tinelle FG, Cicinelli E. The role of hysteroscopy with eye directed biopsy in postmenopausal women with uterine bleeding and endometrial atrophy. Menopause. 2008;15(4):737–42. DOI: https://doi.org/10.1097/gme.0b013e31815b644e

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. Internet J Gynecol Obstet. 2012;16(2):1-5. DOI: https://doi.org/10.5580/2ed9

Güven MA, Pata O, Bakaris S, Kafkasli A, Mgoyi L. Postmenopausal endometrial cancer screening: is there a correlation between transvaginal sonographic measurement of endometrial thickness and body mass index. Eur J Gynaecol Oncol. 2018;25(3):373-5.

Van den Bosch T, Vandendeal A, van Schoubroeck D, Lombard C, Wranz P. Age, weight, BMI and endometrial thickness in postmenopausal women. Acta obstet Gynecol scand. 1996;75:181-2. DOI: https://doi.org/10.3109/00016349609033315

Singh P, Dwivedi P, Mendiratta S. Correlation of endometrial thickness with the histopathological pattern of endometrium in postmenopausal bleeding. J Obst and Gynecol of India. 2019;1;66(1):42-6. DOI: https://doi.org/10.1007/s13224-014-0627-z

Gredmark T, Kvint S, Havel G, Mattsson LÅ. Histopathological findings in women with postmenopausal bleeding. BJOG: An Int J Obst Gynaecol. 1995;102(2):133-6. DOI: https://doi.org/10.1111/j.1471-0528.1995.tb09066.x

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Published

2025-03-27

How to Cite

Joshi, N., Patel, K., Sharma, B. S., Choudhary, N., & Jakhar, B. (2025). Prospective study of role of transvaginal sonography in postmenopausal bleeding and its histopathological correlation: a prospective study from a tertiary care hospital of Rajasthan. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 14(4), 1235–1243. https://doi.org/10.18203/2320-1770.ijrcog20250868

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Original Research Articles