Role of transvaginal sonography in investigating the causes of menorrhagia

To determine the role of transvaginal sonography [TVS] in finding the causes of menorrhagia in patients with no obvious pathology on bimanual examination. This study was conducted in the department of Obstetric and Gynaecology ["A" Unit], Postgraduate Medical Institute, Lady Reading Hospital, Peshawar over a period of one year from 01.11.2003 to 31.10 2004. Married women having menorrhagia with no pelvic mass on bimanual examination underwent TVS in private setup. Unmarried patient, patient with pubertal menorrhagia or postmenopausal patients on hormonal replacement therapy were excluded form the study. After taking detailed history they were thoroughly examined and investigated. Total of 65 cases underwent TVS for menorrhagia. The most common age group was 36-50 year. The commonest cause of menorrhagia on TVS was submucus fibroid of uterus in 38.5% cases [n=25] followed by adenomyosis in 27.9% [n=18] cases, endometrial hyperplasia in 13.07% [n=15], endometrial, polyp in 9.23% [6 cases] and forgotten IUCD in 1.53% [n=1]. TVS is an effective diagnostic tool for finding a cause for abnormal uterine bleeding before proceeding for any operative procedure

Correlation of endometrial thickness, cycle day and histopathology in women with abnormal uterine bleeding

To correlate the endometrial thickness measured by transvaginal sonography [TVS], cycle day and menstrual status with histopathology in women with abnormal uterine bleeding and to evaluate the accuracy of transvaginal sonography in detecting intrauterine abnormalities as compared to hysteroscopy. This prospective study was conducted in the Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital between January 1998 and July 2002. Transvaginal sonography was performed in 160 women with abnormal uterine bleeding, followed within 48 hours by hysteroscopy and endometrial biopsy. Statistical analysis was performed by MacNamar's chi-square test and the various correlations were calculated. No statistically significant association was found between endometrial thickness and cycle day with histopathology. None of the women with endometrial thickness of <5 mm had atypia or malignancy. There was a highly significant association between menstrual status and histology. Transvaginal sonography and hysteroscopy were in agreement in 73.7% of the patients. An endometrial thickness of <5 mm in women with postmenopausal bleeding could mean that curettage can be avoided. No definite cut-off value could be assigned for the menstruating women. Transvaginal sonography is a good initial screening tool in the evaluation of women with abnormal uterine bleeding. Hysteroscopy and histological examination is indicated in cases of abnormal or inconclusive sonograms or if complaints persist after a normal sonogram. Transvaginal sonography seems to be an effective procedure to exclude endometrial and intrauterine abnormalities