A prospective comparative study to evaluate the efficacy of ultrasonography and hysteroscopy and their correlation with the histopathology of endometrium in a case of abnormal uterine bleeding


  • Madhu Kumari Department of Obstetrics & Gynaecology, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
  • Alka S. Gupta Department of Obstetrics & Gynaecology, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India




Abnormal uterine bleeding, AUB, Ultrasonography, Hysteroscopy, Histopathology, Endometrium.


Background: Abnormal uterine bleeding (AUB) is one of the most common complaints that brings a woman to the gynecologist. Key to successful clinical management of AUB is to identify the cause behind it for which proper evaluation of the case is required. In current scenario of increasing cost awareness and taking risk related to invasive procedure hysteroscopy, a balance has to be achieved between the practices of randomly doing all investigation versus a condition appropriate approach. This study was done to compare efficacy of pelvic ultrasonography & hysteroscopy in cases of AUB and their correlation with the histopathology of endometrium.

Methods: In this study 70 women with AUB were selected as they presented in OPD. After evaluation of clinical presentation, general, systemic and local examination, ultrasonography and hysteroscopy were performed on every patient and endometrial curetting were sent for histopathology.

Results: We concluded that ultrasonography has a better efficacy to detect uterine cause of AUB and hysteroscopy is better for detecting intracavitary lesions.

Conclusions: Ultrasonography has a better efficacy to detect uterine cause of AUB. However a thorough history and detailed clinical examination plays a very important role in narrowing the differential diagnosis of AUB. We have developed an algorithmic approach and guidelines for selective use of hysteroscopy in cases of AUB after evaluating the results.


Stovall TG, Photopulos GJ, Poston WM, Ling FW, Sandles LG. Pipelle endometrial sampling in patients with known endometrial carcinoma. Obstet Gynecol. 1991;77(6):954-6.

Lerner JP, Timor-Tritsch IE, Monteagudo A. Use of transvaginal Sonography in the evaluation of endometrial hyperplasia and carcinoma. Obstet Gynecol Survey .1996;51:718-25.

Goldstein SF, Zeltser I, Horan CK, Snyder JR, Schwartz LB. Ultrasonography-based triage for perimenopausal patients with abnormal uterine bleeding. Am J Obstet Gynecol. 1997;177:102-8.

Karlson B, Granberg S, Wikland M, Ylostalo P, Torvid K, Marsal K, et al. Transvaginal ultrasound of the endometrium in women with postmenopausal bleeding--a Nordic multicenter study. Am J Obstet Gynecol. 1995;172(5):1488-94.

Weber AM, Belinson JL, Bradley LD, Piedmonte MR. Vaginal ultrasonography versus endometrial biopsy in women with postmenopausal bleeding. Am J Obstet Gynecol. 1997;177(4):924-9.

Lewis BV. Hysteroscopy for the investigation of abnormal uterine bleeding. Br J Obstet Gynaecol. 1990; 97:283-4.

Loffer FD. Hysteroscopy with selective endometrial sampling compared with D&C for abnormal bleeding: the value of negative hysteroscopic view. Obstet Gynecol. 1989;73:16-20.

Langer RD, Pierce JJ, O'Hanlan KA, Johnson SR, Espeland MA, Trabal JF, et al. Transvaginal ultrasonography compared with endometrial biopsy result. Am J Obstet Gynecol. 1995;172(2Pt1):547-52.

Patil R, Patil RK, Andola SK, Laheru V, Bhandar M. Histopathological spectrum of endometrium in dysfuctional uterine bleeding. Int J Biol Med Res.2013;4(1):2798-801.

Emanuel MH, Verdel MJ, Wamsteker K, Lammes FB. A prospective comparison of transvaginal ultrasonography and diagnostic hysteroscopy in the evaluation of patients with abnormal uterine bleeding: clinical implications. Am J Obstet Gynecol. 1995;172(2pt1):547-52.

Haq K, Chowdhury SF, Mannan M, Ivy R, Tasnim KS. Transvaginal ultrasonography is the diagnostic method for evaluation of abnormal uterine bleeding. Journal of Shaheed Suhrawardy Medical College. 2010;2(1):10-2.

Saidi MH, Sadler RK, Theis VD, Akright BD, Farhart SA, Villanueva GR. Comparison of sonography, sonohysterography, and hysteroscopy for evaluation of abnormal uterine bleeding. J Ultrasound Med. 1997;16(9):587-91.

Bhosle A, Fonseca M. Evaluation and Histopathological Correlation of Abnormal Uterine Bleeding in Perimenopausal Women. Bombay Hospital Journal. 2010;52(1):69-72.

Feitosa IMSD, Feitosa HN, Carvalho FHC, Pereira SM, Medeirosm FC. Comparison between transvaginal ultrasonography and sonohysterography in the assessment of patients with abnormal uterine bleeding. Radiol Bras. 2011;44(3):156-62.

Ryu J, Kim B, Lee J, Kim S, Lee SH. Comparison of Transvaginal Ultrasonography with Hysterosonography as a Screening Method in Patients with Abnormal Uterine Bleeding. Korean J Radiol. 2004;5:39-46 .

Mathlouthi N, Slimani O, Ferchichi A, Temime RB, Makhlouf T, Attia L, et al. Postmenopausal bleeding: Comparison between ultrasonography, hysteroscopy and histopathological results. Tunis Med. 2013;91(2):99-103.






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