ABSTRACT
Background: Saline infusion sonohysterography (SIS) is a simple, safe, reliable, effective and well-tolerated method without complications that complements transvaginal sonography (TVS) in the pre-operative examination of uterine pathology. SIS has been found to be superior to TVS in most studies that have compared their effectiveness in detecting intracavitary lesions and has also been found to decrease the number of diagnostic hysteroscopies to as much as 50%. Patients in whom no intracavitary abnormality is detected by SIS require no further evaluation and are best treated with medical therapy.Methods: The observational study was conducted in the postgraduate department of gynaecology and obstetrics, Lalla Ded Hospital, Government Medical College Srinagar. All consecutive patients with perimenopausal abnormal uterine bleeding attending gynaecology OPD were enrolled in the study after taking informed written consent.Results: SIS has better accuracy than TVS in diagnosing the cause of AUB in perimenopausal women. TVS had sensitivity, specificity and PLR of 60 and 93.8, 9.8, respectively for fibroids while polyps had 27.3, 98.8 and 17.5, respectively, AUP had 81.8, 79.2, 3.9 respectively. SIS had sensitivity, specificity, PLR and NLR values of 80.0, 96.9, 40.7 and 0.21, respectively for diagnosing fibroids, while 63.6, 98.4, 26 and 0.37 respectively for polyp, and 90.9, 94.3, 16.1 respectively for AUP.Conclusions: Accuracy of SIS as a test for detecting pathology in AUB in perimenopausal patients is moderately good and suitable for developing countries.
ABSTRACT
Background: Abnormal uterine bleeding is one of the most frequently encountered conditions in gynaecology practice and forms about 10% of all gynaecological admissions, the main concern in perimenopausal bleeding is that the bleeding could be the only external manifestation of many hidden serious pathologies of uterine-cavity. The objective of this study was to compare the results of transvaginal sonography (TVS) and drug and cosmetic (D and C) with histopathological examination (HPE) report of hysterectomy specimen in perimenopausal women with AUB.Methods: A prospective comparative study where 100 perimenopausal women with AUB were subjected to TVS then D and C and then the results were compared with histopathological report of the hysterectomized specimen.Results: With an endometrial thickness less than or equal to 15 mm the histopathology report is normal endometrium. When the endometrial thickness more than or equal to 15 mm the histopathology report is hyperplasia or carcinoma. Findings of TVS correlated well with histopathological report after hysterectomy. 14 cases of adenomyosis, 16 cases of myomatous polyp, and 6 cases of endometrial polyp missed by dilatation and curettage.Conclusions: TVS is a simple, non-invasive test to indirectly visualize the endometrial cavity and is useful as a first step diagnostic procedure in the evaluation of perimenopausal bleeding. Dilatation and curettage lags in detecting adenomyosis, endometrial and myomatous polyps, When TVS combined with dilatation and curettage, it can supplement the shortcomings of dilatation and curettage.
ABSTRACT
Background: Perimenopausal bleeding is one of the commonest conditions for which patients come to the gynecological outpatient department. The prevalence increases with age peaking just before menopause. Anovulatory cycles causing excessive, uncontrolled and prolonged bleeding, irrespective of the etiology, are the commonest cause for such bleeding in the perimenopausal women. Perimenopause is 2-8 years proceeding and 1 year after menopause. It occurs in women between the ages of 40 to 50 years. Aim: To evaluate the histomorphological profile of Endometrial Biopsies of 200 women with perimenopausal bleeding coming to the Gynaecological outpatient Department Gandhi Hospital, from January to December, 2015. Materials and methods: Endometrial curettings were obtained from 200 women clinically diagnosed to have perimenopausal bleeding. The curettings were fixed in 10% formalin, which were then processed. The slides were stained with Haematoxylin and Eosin (H&E) and their histomorphological pattern was noted. Results: Out of a total of 387 cases with dysfunctional uterine bleeding (DUB), 200 cases had perimenopausal bleeding. Most of the patients were between 46 to 50 years of age. The most important cause of perimenopausal bleeding was proliferative endometrium seen in 85 cases, followed by secretory endometrium in 49 cases. We had 36 cases of fibroids, 16 cases of simple hyperplasia, 5 cases of endometrial polyps, 4 cases of complex hyperplasia without atypia, 3 cases of complex hyperplasia with atypia and 2 cases of endometrial carcinoma. Conclusion: Perimenopausal bleeding is common between the ages of 40 to 50 years, with a peak in the ages between 46 to 50 years. Though the commonest histomorphological profile of the endometrial curettings obtained from such patients was proliferative phase, there were cases of hyperplasia’s both simple and complex with atypia. There were 2 cases of endometrial carcinomas.
ABSTRACT
A total of 365 women were included in this retrospective study that aimed to correlate the transvaginal ultrasound endometrial thickness and histopathology report of the fractional dilatation and curettage among those presenting with perimenopausal bleeding. The incidence of perimenopasual bleeding was 6.32%. Most were in the 46- 50 years age range and were within gravida 1 to 3 presenting with menometrorrhagia. Transvaginal endometrial thickness was mostly within 0.5cm to 1.50cm. Most common endometrial pathology were endometrial polyp, disordered endometrium and simple hyperplasia without atypia. The incidence of adenocarcinoma was 0.8%. There was no significant correlation between age, gravity and parity and the endometrial thickness as measured on transvaginal ultrasound. There was a significant difference in mean endometrial thickness when comparing patients presenting with vaginal spotting and menorrhagia, vaginal spotting and menometrorrhagia and metrorrhagia and menometrorrhagia. There was a statistically significant difference between the endometrial thickness of those with normal histopathology report, meaning endometrium with no pathology and appropriate with menstrual cycle and those with pathologic findings. Using a cut-off of greater than or equal to 1cm for endometrial thickness showed an OR of 3.57, 95%CI 1.24-10.53 for significant pathologic finding on histopathology report with 69.5% sensitivity, 61.1% specificity, 97.2% positive predictive value and a 9.4% negative predictive value.