Transvaginal Ultrasonography and Hysteroscopy in the Diagnosis of Endometrial Abnormalities

Two hundred women (122 premenopausal, 78 postmenopausal) with abnormal uterine bleeding underwent transvaginal ultrasonography, hysteroscopy, and endometrial sampling by curettage or directed biopsy. The ultrasonographic findings were evaluated on the basis of the final diagnosis established by hysteroscopy and histologic examination. In 31 women hysteroscopy detected polyps or submucous myomas, which curettage failed to detect. Evaluating the endometrium ultrasonographically, we used cut-off points of 5 mm (single layer endometrial thickness, follicular phase) for the premenopausal patients and 4 mm (single layer endometrial thickness) for the postmenopausal women. Transvaginal ultrasound had a sensitivity of 88% in diagnosing endometrial abnormalities in premenopausal women and 96% in postmenopausal women. Given these results, transvaginal ultrasound seems to be an excellent first diagnostic method for evaluating the endometrium in the office.