Ultrasonographic evaluation of abnormal uterine bleeding in postmenopausal women

Bindushree Kadakola, G. Gurushankar, Geetha Shivamurthy, M. N. Rashmi


Background: Objectives of current study were to diagnose causes of Abnormal Uterine Bleeding (AUB) in postmenopausal women (PMW) and to correlate it with curettage and histopathological findings, hysteroscopy and thereby minimizing unnecessary interventions in the form of operations and hysteroscopy where sonography depicts normal findings.

Methods: After obtaining ethical clearance present prospective observational study was conducted from November 2010 to November 2012, to evaluate the endometrium in 50 postmenopausal women (PMW) with bleeding per vagina referred to the department of Radio diagnosis by the department of gynaecology in Bangalore medical college and research institute. After applying inclusion and exclusion criterias the cases were evaluated with ultrasonography both transabdominal (TAS) and transvaginal scan (TVS where ever necessary). Histopathological and hysteroscopic correlation was done in all cases.

Results: 58% of the PMW with bleed were in the age group of 51-60 years. Most common cause of PMB was atrophic endometrium (44%), endometrial polyp (22%), followed by malignancy (14%), and hyperplastic endometrium (6%). At Endometrium thickness less than 4 mm there were nil chances of carcinoma.

Conclusions: In women with AUB in postmenopausal age ultrasonography (USG) can be considered as an initial imaging modality for diagnosing endometrial diseases. The sensitivity and specificity of USG for Atrophic endometrium is 100% & 84% respectively with accuracy of 100%, endometrial polyp the specificity is 100% with accuracy of 88%. For malignancy USG showed 100% specificity & accuracy of 100%. Hence USG is highly accurate for evaluating endometrial pathologies. Being noninvasive, less costly & good patient compliance USG should be considered as an initial imaging modality over invasive investigations like D&C, hysteroscopy in evaluating endometrial disorders.


Postmenopausal bleed, Postmenopausal women, Abnormal uterine bleed, Ultrasonography, Transvaginal scan

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William J. Butler, David E. Carnovale. Normal and abnormal uterine bleeding. In: William J. Butler, David E. Carnovale, eds. Te Linde’s Operative Gynaecology, 10th ed. Philadelphia: Lippincott Williams and Wilkins; 2011: 595-598.

Koss LG. Detection of occult endometrial carcinoma. J Cell Biochem. 1995;(Suppl 23):165-73.

Yelamanchi Savitha Devi, Talipeni Swapna K. Diagnostic and Operative Hysteroscopy in The Management of postmenopausal bleeding. J Obstet Gynaecol India. 2001 Mar/Apr;51(2):115-9.

Medverd JR, Dubinsky TJ. Cost analysis model to compare US versus endometrial biopsy in the evaluation of peri- and postmenopausal abnormal vaginal bleeding. Radiology. 2002;222:619-27.

Smith-Bindman R, Kerlikowske K, Feldstein VA, Subak L, Scheidler J, Segal M, et al. Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities. JAMA. 1998;280:1510-7.

Schoenfeld A, Levavi H, Hirsch M, Pardo J, Ovadia J. Transvaginal sonography in postmenopausal women. J Clin Ultrasound. 1990;18:350-8.

Saksouk FA. Endometrium, carcinoma. e-Medicine 2002: 1-29. Available at: http://emedicine.medscape.com/article/403578-overview. Accessed 12 July 2013.

Langlois JP, Turner LF, Aitken PV Jr. Can transvaginal ultrasound detect endometrial disease among asymptomatic postmenopausal patients? J Fam Pract. 2004 Dec;53(12):1003-4.

Parazzini F, La Vecchia C, Bocciolone L, Franceschi S. The epidemiology of endometrial cancer. Gynaecol Oncol. 1991;41:1-16.

Nasri MN, Coast GJ. Correlation of ultrasound findings and endometrial histopathology in postmenopausal women. Br J Obstet Gynaecol. 1989;96:1333-8.

Kaur M, Singh R, Sharma M. Endovaginal sonographic evaluation of postmenopausal uterine bleeding. J Clin Diagn Res. 2010;(4):2175-82.

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

Brinton LA, Berman MC, Mortel R, Twiggs LB, Barett RJ, Wilbanks GD, et al. Reproductive, menstrual and medical risk factors for endometrial carcinoma: results from case control study. Am J Obstet Gynaecol. 1993;81:265-71.

Saksouk FA. Endometrium, carcinoma. e-Medicine 2002: 1-29. Available at: http://emedicine.medscape.com/article/403578-overview. Accessed 12 July 2013.

Schei B, Bang TF, Halgunset J, Haugen OA, Tlaarsatd I, Onsrud M. Microcurettage sampling of the endometrium for histopathological examination: simpler but not safe? Comparison of endometrial 143 histopathology in samples obtained by a disposable mechanical curette and by traditional curettage. Acta Obstet Gynecol Scand. 1994;73:497-501.

Karlsson B, Granberg S, Wikland M, Ylöstalo P, Torvid K, Marsal K, et al. Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding: a Nordic multicentre study. Am J Obstet Gynaecol. 1995;172:1488-94.

Granberg S. Sonography of the endometrium in the post-menopausal woman. Ann Med. 1994;26:81-3.

Goldstein SR, Nachtigall M, SnyderJR, Nachtigall L. Endometrial assessment by vaginal ultrasonography before endometrial sampling in patients with postmenopausal bleeding. Am J Obstet Gynaecol. 1990;163:119-23.

Gull B, Carlsson S, Karlsson B, Ylostalo P, Milsom I, Granberg S. Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding: is it always necessary to perform an endometrial biopsy? Am J Obstet Gynaecol. 2000;182:509-15.

Gull B, Karlsson B, Milsom I, 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 Gynaecol. 2003;188:401-8

Alcazar JL, Laparte C. Comparative study of transvaginal ultrasonography and hysteroscopy in postmenopausal bleeding. Gynaecol Obstet Invest. 1996;41(1):47-9.

Conoscenti G, Meir YJ, Fischer-Tamarol L, Maieron A, Natale R, D’Ottavio G, et al. Endometrial assessment by transvaginal sonography and histological findings after D & C in women with postmenopausal bleeding. Ultrasound Obstet Gynaecol. 1995 Aug;6(2):108-15.