Evaluation of endometrial thickness with transvaginal ultrasonography in perimenopausal women presenting with abnormal uterine bleeding and correlation with its histopathological findings

Noor Ayesha Begum, Lokesh Chandra H. C., Ravindra S. Pukale


Background: Abnormal uterine bleeding is the most common presenting menstrual complaint in women of perimenopausal age group. Most frequently used diagnostics tests to investigate the causes of abnormal bleeding are Transvaginal ultrasonography (TVS) and endometrial biopsy. Uterine curettage is an invasive procedure and is performed with anaesthesia. TVS is a non-invasive method that has been used to evaluate the endometrium and uterine cavity. The objectives of this study were to measure and evaluate the role and accuracy of endometrial thickness by transvaginal ultrasonography study to detect endometrial pathology in perimenopausal women presenting with Abnormal Uterine Bleeding. To correlate the transvaginal sonographic results with the Histopathological findings to discriminate normal from pathological endometrium.

Methods: Prospective study including 150 perimenopausal women with abnormal uterine bleeding. Endometrial thickness was measured by TVS and then D and C was performed for all the patients.

Results: Out of 150 women, 128 (85.3%) had normal and 22 (15%) had an abnormal endometrium. 43.3% were of 41-45 years and 65.3% patients presented with complaint of heavy menstrual bleeding. Majority of the patients in the study group were para 2 or more. Fibroid uterus (24%) was the commonest uterine pathology detected on TVS. 53.3% of patients had endometrial thickness in the range 10-14.9 mm. Most common finding on HPE was secretory endometrium (44.6%). Endometrial carcinoma was found in 3%. Endometrial thickness <14mm was associated with least abnormal endometrial pathology.

Conclusions: Endometrial thickness of less than 14 mm need not be indicated for D and C in perimenopausal abnormal uterine bleeding. In perimenopausal women with AUB, TVS should be the investigation of choice due to its convenience, accuracy and non- invasiveness.


Abnormal uterine bleeding, Dilatation and curettage, Endometrial thickness, Perimenopause, Transvaginal ultrasonography

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Agarwal S, Azam R, Diwan C, Jain S. Transvaginal sonographic assessment of endometrium a prospective cohort study. Int Mournal Sci. 2014;2(7):50-2.

Qureshi A, Ali F, Malik L, Ali A, Mushtaq S. Accuracy of transvaginal sonography in detecting endometrial abnormalities in women with peri and postmenopausal bleeding. Int Mournal Adv Res. 2015;3(9):1084-90.

Ozdemir S, Celik C, Gezginc K, Kiresi D, Esen H. Evaluation of endometrial thickness with transvaginal ultrasonography and histopathology in premenopausal women with abnormal vaginal bleeding. Arch Gynaecol Obstet. 2010;282:395-9.

Roy PK, Singh P, Singh VK, Mahadik K, Jain R. Endometrial thickness as a test for endometrial cancer in women with abnormal postmenopausal and perimenopausal vaginal bleeding and its histopathological correlation. 1JIRM. 2013;4(2):144-8.

Dubinsky TJ. Value of sonography in the diagnosis of abnormal vaginal bleeding. J Clin Ultrasound. 2004;32:348-53.

Gupta JK, Chien PFW, Voit D, ClarN TJ, Khan KS. Ultrasonographic, endometrial thickness for diagnosing endometrial pathology in women with postmenopausal bleeding: a meta analysis. Acta Obstet Gynecol Scand. 2002;81:799-816.

Smith-Bindman R, Kerlikowske K, Feldstein VA. Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities. JAMA. 1998;280:1510.

Van Doorn LC, DiMNhuizen PHLJ, Kruitwagen RFMP, Heintz AP, Kooi GS, Mol BW. DUPOMEB (Dutch Study in Postmenopausal Bleeding): accuracy of transvaginal ultrasonography in diabetic and or obese women with postmenopausal bleeding. Obstet Gynecol. 2004;104:571-8.

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 Gynecol. 2003;188:401-8.

Goldstein RB, Bree RL, Benson CB. Evaluation the women with postmenopausal bleeding: Society of radiologists in ultrasound-sponsored concensus conference statement. J Ultrasound Med. 2001;20:1025-36.

Sajitha K, Padma SK, Shetty KJ, KishanPrasad HL, Permi HS, Hegde P. Study of histopathological patterns of endometrium in abnormal uterine bleeding. CHRISMED J Health Res. 2014;1(2):76.

Patil SG, Bhute SB, Inamdar SA, Acharya S, Shrivastava DS. Role of diagnostic hysteroscopy in Abnormal Uterine Bleeding and its histopathological correlation. J Gynecol Endoscopic Surg. 2009:98-104.

Shobhitha GL, Kumari VI, Priya PL, Sundari BT. Endometrial study by TVS and It’s correlation with histopathology in abnormal uterine bleeding. J Dental Med Sci. 2015;14(4):21-32.

Cornitescu F, Tanase F, Simionescu C, Iliescu D. Clinical, histopathological and therapeutic consideration in non-neoplastic Abnormal Uterine Bleeding in menopause transition. Rom J Morphol Embryol. 2011;52:759-65.

Jetley S, Rana S, Jairajpuri ZS. Morphological spectrum of endometrial pathology in middle aged women with atypical uterine bleeding - a study of 219 cases. J Midlife Health. 2013;4:216-20.

Sur D, Chakravorty R. Correlation of endometrial thickness and histopathology in women with abnormal uterine bleeding. Repro Syst Sexual Dis. 2016;5(4):1-3.

Getpook C, Wattanakumtornkul S. Endometrial thickness screening in premenopausal women with abnormal uterine bleeding. J Obstet Gynaecol Res. 2006;32:588-92.

Fakhar S, Saeed G, Khan AH, Alam AY. Validity of pipelle endometrial sampling in patient with abnormal uterine bleeding. Ann Saudi Med. 2008;28:188-91.

Aslam A, Gazala. Role of TVS in cases of abnormal uterine bleeding. Profesional Med J. 2009;(16)1:127-34.

Khans, Hameed S, Umber A. Histopathological pattern of endometrium on diagnostic D and C in patient with abnormal uterine bleeding. ANNALS. 2011;17:166-70.

Acharya V, Mehta S, Randan A. Evaluation of DUB by TVS, hysteroscopy and histopathology. J Obstet Gynaecol India. 2003;53(2):170-7.