Published: 2018-12-26

Hysteroscopy: an effective tool in post-menopausal bleeding

K. K. Junnare, G. J. Desai, G. S. Shekhawat


Background: Postmenopausal bleeding is a condition where endometrial carcinoma is to be ruled out. Traditionally, D and C is the preferred method for diagnosis in such condition. Other diagnostic modalities like trans vaginal ultrasonography (TVS) and hysteroscopy are being used for diagnosis in the cases of PMB. The objective of this study is to evaluate the efficacy and accuracy of TVS and hysteroscopy in women with postmenopausal bleeding (PMB).

Methods: One hundred postmenopausal women with vaginal bleeding underwent TVS and hysteroscopy. Endometrial tissue was obtained by curettage and sent for histopathology examination. The results of TVS and Hysteroscopy were compared against HP report.

Results: Hysteroscopy was successful in 98 patients. Endometrial histopathology revealed proliferative, secretory and atrophic endometrium in 26, 7 and 23 patients respectively. Polyp was diagnosed in 13 patients. Endometrial hyperplasia was detected in 11 patients and endometrial malignancy in 14 patients. All patients with endometrial hyperplasia and malignancy had ET (endometrial thickness) more than 4 mm, except one patient with endometrial malignancy who had 4 mm ET. The sensitivity and specificity of TVS for suspecting endometrial pathology at ET 4mm were 93% and 69.6%, respectively. Hysteroscopy had sensitivity of 95.2%, specificity of 92.8%, with diagnostic accuracy of 93.8%.

Conclusions: Hysteroscopy was found to be the more sensitive and specific than Transvaginal sonography for diagnosing endometrial pathologies. Hysteroscopy is safe and effective for detecting endometrial pathologies in patients with PMB.


Endometrial malignancy, Hysteroscopy, Postmenopausal bleeding (PMB), Transvaginal ultrasonography (TVS)

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Brand AH. The woman with postmenopausal bleeding. Aus Fam Physic. 2007;36(3):116.

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(17):1510-7.

Kaur M, Singh R, Sharma M. Endovaginal sonographic evaluation of postmenopausal uterine bleeding. J Clin Diagn Res. 2010;4(2):2175-82.

Dawood NS, Peter K, Ibrar F, Dawood A. Postmenopausal bleeding: causes and risk of genital tract malignancy. J Ayub Med Coll Abbottabad. 2010;22(2):117-20.

Birinyi L, Daragó P, Török P, Csiszar P, Major T, Borsos A, et al. Predictive value of hysteroscopic examination in intrauterine abnormalities. Europ J Obstet Gynecol Reprod Biol. 2004;115(1):75-9.

Tabor A, Watt HC, Wald NJ. Endometrial thickness as a test for endometrial cancer in women with postmenopausal bleeding. Obstet Gynecol. 2002;99(4):663-70.

Litta P, Merlin F, Saccardi C, Pozzan C, Sacco G, Fracas M, et al. Role of hysteroscopy with endometrial biopsy to rule out endometrial cancer in postmenopausal women with abnormal uterine bleeding. Maturitas. 2005;50(2):117-23.

Timmermans A, Opmeer BC, Khan KS, Bachmann LM, Epstein E, Clark TJ, et al. Endometrial thickness measurement for detecting endometrial cancer in women with postmenopausal bleeding: a systematic review and meta-analysis. Obstet Gynaecol. 2010;116:160-7.

Singh P, Dwivedi P, Mendiratta S. Correlation of endometrial thickness with the histopathological pattern of endometrium in postmenopausal bleeding. J Obstet Gynecol India. 2016;66(1):42-6.

Wong AS-W, Lao TT-H, Cheung CW, Yeung SW, Fan HL, Ng PS, et al. Reappraisal of endometrial thickness for the detection of endometrial cancer in postmenopausal bleeding: a retrospective cohort study. BJOG. 2016;123:439-46.

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 Obstet Gynecol Scand. 1994;73(10):819-23.

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 multicenter study. Am J Obstet Gynecol. 1995;172(5):1488-94.

Gull B, Carlsson S, Karlsson B, Yleostalo 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.

Garuti G, Sambruni I, Cellani F, Garzia D, Alleva P, Luerti M. Hysteroscopy and transvaginal ultrasonography in postmenopausal women with uterine bleeding. Int J Gynecol Obstet. 1999;65(1):25-33.

Sousa R, Silvestre M, Sousa LA, Falcão F, Dias I, Silva T, et al. Transvaginal ultrasonography and hysteroscopy in postmenopausal bleeding a prospective study. Acta Obstet Gynecol Scand. 2001;80(9):856-62.

Tandulwadkar S, Deshmukh P, Lodha P, Agarwal B. Hysteroscopy in postmenopausal bleeding. J Gynecol Endosc Surg. 2009;1(2):89-93.

Tinelli R, Tinelli FG, Cicinelli E, Malvasi A, Tinelli A. The role of hysteroscopy with eye-directed biopsy in postmenopausal women with uterine bleeding and endometrial atrophy. Menop. 2008;15(4):737-42.