ABSTRACT
To determine the diagnostic value of transvaginal ultrasonography in the detection of endometrial abnormalities in women with postmenopausal bleeding. Study 150 women with postmenopausal bleeding were clinically evaluated by transvaginal ultrasonography and curettage. The endometrial thickness as measured by transvaginal ultrasonography was compared with the histopathological diagnosis of the curettage specimens. El-Minia University Hospital. Women receiving hormone replacement therapy [n= 30] with a normal endometrium had a mean endometrial thickness of 5.22 +/- 3.74 mm [n=16] and women receiving hormone replacement therapy with an abnormal endometrium had an endometrial thickness of 11.2 +/- 6.6mm [n=14]. The corresponding figures for women who did not use hormone replacement therapy [n=120] were 4.44 +/- 2.16 mm [n=63] and 14.63 +/- 8.9 mm [n=57] respectively. The mean endometrial thickness of atrophic endometrium, hyperplasia, polyp, cancer and proliferative / secretory endometrium were each 3.09 +/- 1.67 mm, 11.76 +/- 6.98 mm, 10.87 +/- 4.71 mm, 21.95 +/- 8.09 mm and 4.52 +/- 1.88 mm respectively. At a cutoff limit of 5mm for endometrial thickness, the sensitivity of transvaginal ultrasonography for detecting a histologically abnormal endometrium was 91.5%, the specificity 86%, the positive predictive value 85.5% and the negative predictive value 91.8%. Transvaginal ultrasonography with measurement of endometrial thickness is a safer and a non invasive outpatient procedure which has the advantage of not only predicting endometrial abnormality but also and perhaps more importantly, excluding pelvic pathology