The role of transvaginal ultrasonography in evaluating the endometrium of women with postmenopausal bleeding
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20252373Keywords:
Postmenopausal bleeding, Transvaginal ultrasound, Endometrial thickness, Endometrial cancer, Hormonal replacement therapy, Gynaecologic imaging, Endometrial pathology, Kampala international university, Yei civil hospitalAbstract
Postmenopausal bleeding (PMB) is a clinically relevant symptom that should be evaluated promptly due to its linkage to endometrial pathology, including endometrial cancer. For women who present with PMB, transvaginal ultrasonography (TVUS) has become a first-line, non-invasive imaging method for assessing the endometrium. The objective of this review article is to compile the most recent data regarding the diagnostic utility, uses, limitations, and technological advancement of transvaginal ultrasonography in evaluating endometrial pathology in postmenopausal women. Recent clinical research, case reports, and multicentre trials were thoroughly examined with an emphasis on the use of TVUS in the diagnosis of endometrial atrophy, hyperplasia, polyps, fibroids, and cancer. Further assessment was conducted on its usefulness in specific groups, including women on hormone replacement therapy (HRT) and those experiencing recurrent PMB. With a cut-off value of less than 4 mm, TVUS has a good negative predictive value for endometrial cancer and is useful for evaluating endometrial thickness. It greatly lessens the need for invasive procedures in low-risk patients, but it cannot replace a histopathology. Diagnostic accuracy has increased due to recent advancement including 3D imaging, Doppler flow analysis, and artificial intelligence integration. Its usefulness in directing therapeutic management and enhancing early diagnosis is supported by case studies and clinical trials. For the first assessment of postmenopausal bleeding, transvaginal ultrasonography is an essential, safe, and cost-effective procedure. Its increased usage in gynaecologic diagnostics is supported by its high sensitivity and recent technological advancements, but histological confirmation is still necessary in cases where questionable results are found.
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Papakonstantinou E, Adonakis G. Management of pre-, peri-, and post-menopausal abnormal uterine bleeding: When to perform endometrial sampling. International J Gynecol Obst. 2020;158(2):252–9. DOI: https://doi.org/10.1002/ijgo.13988
Adachi T, El-Hattab AW, Jain R, Nogales Crespo KA, Quirland Lazo CI, Scarpa M. Enhancing equitable access to rare disease diagnosis and treatment around the world: A review of evidence, policies, and challenges. International J Envir Res Publ Heal. 2023;20(6):4732. DOI: https://doi.org/10.3390/ijerph20064732
Detti L. Reproductive imaging. In Clinical Reproductive Medicine and Surgery: A Practical Guide. Springer International Publishing. 2009: 109-37. DOI: https://doi.org/10.1007/978-3-030-99596-6_5
Morimasa A. Differentiating benign and malignant endometrial lesions in postmenopausal women using transvaginal ultrasound: A case study. Gynecol Oncol Rep. 2023;46:100892.
Chandra V, Kim JJ, Benbrook DM, Dwivedi A, Rai R. Therapeutic options for management of endometrial hyperplasia. J Gynecol Oncol. 2016;27(1):8. DOI: https://doi.org/10.3802/jgo.2016.27.e8
Zhang Q. Endometrial polyps and their relationship with hormone therapy: A retrospective analysis. Menopause J North Am Menop Soc. 2022;29(8):909–16.
Van Nyen T, Moiola CP, Colas E, Annibali D, Amant F. Modeling endometrial cancer: Past, present, and future. Int J Mol Sci. 2018;19(8):2348. DOI: https://doi.org/10.3390/ijms19082348
Committee on Gynecologic Practice. The role of transvaginal ultrasonography in evaluating the endometrium of women with postmenopausal bleeding. Obstet Gynecol. 2018;131(5):124-9. DOI: https://doi.org/10.1097/AOG.0000000000002631
Sharma J, Dhiman B, Sud N, Kaushik A. Synergistic approach in diagnosing endometrial disease in women with postmenopausal bleeding. Int J Reprod Contracept Obstet Gynecol 2017;6:4081-9 DOI: https://doi.org/10.18203/2320-1770.ijrcog20174066
Goldstein SR. The role of transvaginal ultrasound or endometrial biopsy in the evaluation of the menopausal endometrium. American J Obst Gynecol. 2009;201(1):5–11. DOI: https://doi.org/10.1016/j.ajog.2009.02.006
Pal R, Naik B, Puttana VN. Abnormal uterine bleeding in peri and postmenopausal women: Comparison of efficacy of saline infusion sonography with transvaginal sonography. International J Res Med Sci. 2022;10(11):2450. DOI: https://doi.org/10.18203/2320-6012.ijrms20222840
Muzii L. The role of transvaginal ultrasonography in managing postmenopausal bleeding in women on hormone replacement therapy: A multicenter trial. Menopause. 2022;29(12):1357–65.
Lieng M, Istre O, Qvigstad E. A randomized controlled trial comparing transvaginal ultrasonography and endometrial biopsy in the evaluation of postmenopausal bleeding. Ultrasound Obst Gynecol. 2022;12:443.
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