Role of Ultrasound in the Assessment of Postmenopausal Bleeding

Abstract

Uterine bleeding is a symptom seen by gynecologists in approximately 70% of their visits with women of peri and postmenopausal age. A common symptom, postmenopausal bleeding sometimes can be indicative of malignant pathology. While traditional diagnosis took place via endometrial biopsy, diagnosis is trending toward the use of ultrasound. Benefits of ultrasound include its noninvasive nature, decreased cost, and increased accuracy in diagnosis of postmenopausal bleeding. We present a case-based approach to the usage of various ultrasonography techniques including 2D and color Doppler ultrasound, saline infusion sonography (SIS), 3D and 3D power Doppler ultrasound, as complements to traditional diagnosis of endometrial biopsy. In each of the cases, ultrasonography reveals the diagnosis of postmenopausal pathologies, including atrophic endometrium, endometrial polyps, endometrial hyperplasia, and the malignant pathology, such as endometrial carcinoma, uterine leiomyosarcoma and cervical carcinoma. By the end of our case-based discussion, learners are encouraged to test their knowledge in self-assessment quiz.

Predictive value of transvaginal ultrasound score for detection of endometrial malignancy

“…The ultrasound examination with colour Doppler enabled a detailed examination of the thickness, structure, and flow through the endometrium prior to intervention. They placed the cut-off of the thickness of endometrium at five mm and each patient was examined separately, depending on a lower or higher cancer risk, which is consistent with the present research [16].…”

Role of transvaginal ultrasonography and colour Doppler in the evaluation of postmenopausal bleeding

“…Postmenopausal bleeding (PMB) can be defined as uterine bleeding occurring at least one year after menopause, its incidence can be as high as 10% (2). The differential diagnosis of postmenopausal bleeding is wide, and includes, endometrial hyperplasia, endometrial polyp, endometrial carcinoma, cervical cancer and uterine leiomyosarcoma (3). It is estimated that 10-15% of patients who present with postmenopausal bleeding end up having endometrial cancer (4).…”