Sonohysterography for the Diagnosis of Endometrial Thickening in Postmenopausal Bleeding-A Preliminary Report

Sonohysterography or sonographic uterine cavity visualization by uterine cavity distension may help in distinguishing true endometrial thickening from other intracavitary pathologic conditions assuming the same appearance on conventional sonography. We examined 15 women with thickened endometrium (range 10-25 mm) on sonography performed for postmenopausal bleeding. Subsequent sonohysterography with saline revealed a polypoid structure in seven women, a normal uterine cavity in four, and thickened endometrium in four. All patients underwent hysteroscopic evaluation of the uterine cavity. Hysteroscopy confirmed the sonohysterographic findings in 14 patients (93.3%). Hysteroscopic resection of the polypoid structures was performed while the remaining patients underwent diagnostic curettage. Histologic examination of the seven polypoid structures revealed benign endometrial polyp in six and one pedunculated submucous fibroid. In patients undergoing diagnostic curettage, histologic examination revealed three cases of glandular hyperplasia, one case of cystic (atrophic) hyperplasia, one case of papillary endometrial adenocarcinoma, and two cases were inadequate for diagnosis. The advantage of sonohysterography in distinguishing endometrial thickening from intracavitary polyp or fibroid is clearly demonstrated. This technique can help in tailoring the correct treatment in various conditions presenting as postmenopausal bleeding.