TRANSVAGINAL SONOGRAPHIC EVALUATION OF THE ENDOMETRIUM IN DELAYED MENOPAUSE

Abstract

Postmenopausal bleeding requires careful evaluation to detect the cause of bleeding and to exclude the possibility of malignancy among the postmenopausal women. Uterine causes of postmenopausal bleeding include, atrophic endometrium, hyperplastic endometrium, endometrial polypi and endometrial carcinoma. Although fractional curettage is the gold standard for diagnosis of such conditions yet the procedure has certain limitations, being an invasive procedure requires general anaesthesia, together with the possibility of missing intrauterine pathological lesions.

With high frequency transvaginal sonography the endometrium can be clearly visualized as it produces a clear uterine image because of the proximity of the vaginal probe to the uterus, together with its value to detect other uterine or adnexal abnormalities which could also explain the cause of the bleeding episode. Transvaginal sonography could demonstrate changes in the thickness and morphology of the endometrium. In the menopause, the normal endometrium becomes thin and atrophic as a result of lack of epithelial stimulation. The atrophic mucosa is prone to superficial punctate ulceration. This can result in senile endometritis and probably represents the cause of bleeding when there is scanty tissue obtained by curettage. Endometrial hyperplasia appears by vaginal ultrasound as a well defined thick, highly reflective layer occupying the whole uterine cavity. The presence of enlarged uterine cavity, irregular intrauterine echoes, and high intensity echoes appeared to be non specific criteria used as an additional ultrasonographic findings to thickened endometrium in cases of endometrial carcinoma. Several studies have been performed testing the sensitivity of transvaginal sonography in the diagnosis of abnormal uterine bleeding.

This study was designed to evaluate the role of transvaginal sonography as a diagnostic and screeing investigation to detect endometrial pathology in cases with postmenopausal bleeding. We recommended the routine use of transvaginal sonography for women with postmenopausal bleeding.

It improves the possibility of diagnosing edometrial carcinoma at any early stage.

Meanwhile, in cases in whom the endometrium apear normal by transvaginal sonography, the womam will be spared an unnescessary operation.

Furthermore, endometrial sonography can be used to screen woman periodically who are at high risk of endometrial carcinoma. One could follow women with thin endometrium and biopsy those who show an increase in the endometrial thickness. Biopsy is essential for those with postmenopausal bleeding.