Replacing diagnostic curettage by vaginal ultrasound

Dilatation and curettage has for many years been the method of choice for diagnosing endometrial cancer in postmenopausal women. However, less than 10% of women with postmenopausal bleeding have an endometrial cancer. Vaginal sonography for measuring endometrial thickness, has in several studies proved to be a sensitive diagnostic method for diagnosing endometrial pathology. Our studies as well as others have shown that an endometrial thickness of 4 mm or less (including both endometrial layers) indicates a very low risk for endometrial carcinoma as well as any other major endometrial pathology in women with postmenopausal bleeding. Since vaginal sonography is such a simple and a non-invasive diagnostic method, it thus seems reasonable that vaginal sonographic assessment of the endometrium should be the primary method for excluding any endometrial abnormality in a woman with postmenopausal bleeding.