Abnormal uterine bleeding in peri-menopausal age: Diagnostic options and accuracy

Abstract

:Objectives: Various diagnostic techniques have been evolved over the periods to determine the etiology of abnormal uterine bleeding in peri-menopausal women, but their accuracy has not been compared properly. In this study diagnostic accuracy of trans-vaginal sonography (TVS), saline infusion sonography (SIS) and dilatation & curettage (D & C) were compared with hysteroscopic guided biopsy to determine the etiology. Methods: In this study, 252 patients had to undergo trans-vaginal sonography and saline infusion sonography in the same sitting followed by hysteroscopic-guided biopsy and dilatation and curettage. All the materials were sent for histopathological examination. Results: In determining uterine pathology, positive likelihood ratio (PLR) of TVS, SIS and D & C are 2.81, 7.5 and 3.81 respectively considering hysteroscopy as standard. Conclusion: Sensitivity of SIS as a test for detecting pathology in abnormal uterine bleeding (AUB) is high and can be easily performed on out patient basis. D&C has a very low sensitivity and is unacceptable as a screening test for the same conditions.

Role of hysteroscopy in management of abnormal uterine bleeding in perimenopausal women

“…24.6% which was close to that observed in Jyotsana et al and Dasgupta et al which was 22.6% and 30.6% respectively but was much lower than observed in Rethu et al study which was 50%. 3,6,4 Atrophic endometrium was present in 10.4% of cases in our study which was close to that observed in Sheetal et al which was 8% and was much less in Reethu et al study i.e. 2%.…”

“…8,6 Close to this value, was in the study by Reethu et al and Jyotsna et al who observed normal hysteroscopic findings in 30% and 33.3% of cases, respectively. 4,5 Most common abnormality detected was hyperplastic endometrium i.e.…”

“…3,4 Majority of the patients (64%) were multiparous in our study, and was similar as also reported by Jyotsana et al and Shubhankar D et al where majority of patients to be multiparous (54.7% and 88.5% respectively). 5,6 Fonsena M et al also observed majority of the patients were multiparous 60%. 7 Commonest presentation in the study was menorrhagia in 40% patients, followed by post-menopausal bleeding seen in 22% patients.…”

Comparative study of saline infusion sonography and hysteroscopy for evaluation of uterine cavity in abnormal uterine bleeding

“…This finding is reflected in other studies as shown in Table 4. 9,11,12 The least sensitivity for detection with saline infusion sonography was for submucosal fibroids. 5 patients were diagnosed with submucosal fibroids during SIS.…”

Evaluation of uterine fibroids as a cause of AUB by pelvic ultrasound

“…Dasgupta et al [5] evaluated the diagnostic options and accuracy of abnormal uterine bleeding in perimenopausal women found the sensitivity and specificity of TVS for fibroids is 65.7%% and 95.4% respectively.…”