{"paper_id":"3dc67f49-3ed8-4515-b455-305a76783291","body_text":"~ 877 ~ \nInternational Journal of Clinical Obstetrics and Gynaecology 2026; 10(4): 877-880 \n \nISSN (P): 2522-6614 \nISSN (E): 2522-6622 \nIndexing: Embase \nImpact Factor (RJIF): 6.71 \n© Gynaecology Journal \nwww.gynaecologyjournal.com \n2026; 10(4): 877-880 \nReceived: 20-04-2026 \nAccepted: 22-05-2026 \n \nDr. Minakshi Pounikar \nAssistant Professor, Department of \nObstetrics and Gynaecology \nDatta Meghe Medical College, \nNagpur, Maharashtra, India  \n \nDr. Snehal Deshmukh \nAssistant Professor, Department of \nObstetrics and Gynaecology, Datta \nMeghe Medical College, Nagpur, \nMaharashtra, India  \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nCorresponding Author: \nDr. Minakshi Pounikar \nAssistant Professor, Department of \nObstetrics and Gynaecology \nDatta Meghe Medical College, \nNagpur, Maharashtra, India  \n \nRole of Transvaginal Ultrasonography in the Evaluation \nof Abnormal Uterine Bleeding \n \nMinakshi Pounikar and Snehal Deshmukh \n \nDOI: https://www.doi.org/10.33545/gynae.2026.v10.i4k.2586  \n \nAbstract \nBackground: Abnormal uterine  bleeding (AUB) is one of the most common gynecological complaints \naffecting women of reproductive and perimenopausal age. Transvaginal ultrasonography (TVUS) is widely \nused as the initial imaging modality for identifying the underlying causes of AUB. \nObjectives: To evaluate the role of transvaginal ultrasonography in women presenting with abnormal \nuterine bleeding and to assess its diagnostic performance in detecting endometrial pathology. \nMethods: This prospective observational study included 150 women  with abnormal uterine bleeding \nattending a tertiary care hospital. Detailed clinical evaluation and transvaginal ultrasonography were \nperformed in all participants. Ultrasonographic findings , endometrial thickness, and uterine abnormalities \nwere recorded. Hi stopathological examination was used for correlation wherever indicated. Data were \nanalyzed using IBM SPSS Statistics version 25.0 , and a p-value <0.05  was considered statistically \nsignificant. \nResults: The mean age of participants was 43.9 ± 9.6 years , with the majority (40.0%) belonging to the \n41–50 years age group. Heavy menstrual bleeding was the most common presenting complaint (48.0%). \nLeiomyoma (32.0%) was the most frequent ultrasonographic finding , followed by endometrial hyperplasia \n(18.7%) and ade nomyosis (13.3%). Women aged 41 –50 years had significantly greater endometrial \nthickness (p = 0.018). TVUS demonstrated a sensitivity of 91.2%, specificity of 87.5%, positive predictive \nvalue of 88.6% , negative predictive value of 90.3% , and an overall dia gnostic accuracy of 89.3% for \ndetecting endometrial pathology. \nConclusion: Transvaginal ultrasonography is an effective and accurate first -line diagnostic tool for \nevaluating abnormal uterine bleeding. Its high diagnostic accuracy and non -invasive nature m ake it \nvaluable for the early detection of uterine and endometrial abnormalities , thereby guiding appropriate \nclinical management. \n \nKeywords: Abnormal uterine bleeding , Transvaginal ultrasonography , Endometrial thickness , \nLeiomyoma, Endometrial hyperplasia, Diagnostic accuracy \n \nIntroduction  \nAbnormal uterine bleeding (AUB) is one of the most common gynecological complaints \naffecting women of reproductive and perimenopausal age and accounts for a substantial \nproportion of outpatient visits. It is defined as bleeding from the uterine corpus that is abnormal \nin volume , regularity, frequency, or duration and occurs in the absence of pregnancy. The \nInternational Federation of Gynaecology and Obstetrics (FIGO) introduced the PALM -COEIN \nclassification system to stan dardize the etiological diagnosis of AUB into structural and non -\nstructural causes , thereby improving clinical evaluation and management [1, 2]. Transvaginal \nultrasonography (TVUS) has emerged as the first -line imaging modality for evaluating women \nwith AU B because it is non -invasive, widely available , cost-effective, and provides excellent \nvisualization of the uterus , endometrium, ovaries, and adnexa. It plays an important role in \nidentifying structural abnormalities such as leiomyomas , endometrial polyps , adenomyosis, \nendometrial hyperplasia, and endometrial carcinoma while also assessing endometrial thickness \nand morphology [3, 4]. Several studies have demonstrated that measurement of endometrial \nthickness by TVUS has high sensitivity for detecting endome trial pathology , particularly in \npostmenopausal women with bleeding. Its diagnostic accuracy has made TVUS an indispensable \ninitial investigation before proceeding to invasive procedures such as endometrial biopsy or \nhysteroscopy [5, 6]. In addition to eva luating endometrial pathology , TVUS combined with \nDoppler imaging improves the characterization of endometrial lesions and contributes to the \ndiagnosis of adenomyosis and other uterine abnormalities, thereby facilitating appropriate  \n\n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n~ 878 ~ \ntreatment planning [7, 8]. Considering its widespread use and \ndiagnostic utility, the present study was undertaken to evaluate \nthe role of transvaginal ultrasonography in women presenting \nwith abnormal uterine bleeding attending a tertiary care hospital. \n \nMaterials and Methodology \nStudy Design \nThis was a hospital -based prospective observational study \nconducted to evaluate the role of transvaginal ultrasonography in \nthe assessment of abnormal uterine bleeding. \n \nStudy Setting \nThe study was carried out in the Department of Obstet rics and \nGynaecology, in collaboration with the Department of \nRadiodiagnosis, at a tertiary care teaching hospital. \n \nStudy Duration \nThe study was conducted over a period of 18 months after \nobtaining approval from the Institutional Ethics Committee. \n \nStudy Population \nWomen presenting with complaints of abnormal uterine \nbleeding and referred for transvaginal ultrasonography were \nincluded in the study. \n \nSample Size \nA total of 150 women with abnormal uterine bleeding were \nenrolled consecutively during the study period. \n \nInclusion Criteria \n Women aged 18 years and above presenting with abnormal \nuterine bleeding. \n Premenopausal, perimenopausal, and postmenopausal \nwomen with uterine bleeding. \n Patients willing to provide written informed consent. \n \nExclusion Criteria \n Pregnancy or pregnancy-related bleeding. \n Known bleeding disorders. \n Acute pelvic inflammatory disease. \n Patients with cervical malignancy diagnosed on clinical \nexamination. \n Women unwilling to participate. \n \nStudy Procedure \nAfter obtaining informed written cons ent, a detailed history \nregarding age, parity, menstrual history, duration and pattern of \nbleeding, medical illnesses , and drug history was recorded. \nGeneral physical and gynecological examinations were \nperformed. \nAll participants underwent transvaginal ul trasonography \n(TVUS) using a high -frequency (5 –9 MHz) transvaginal probe \nby an experienced radiologist. The following parameters were \nevaluated: \n Endometrial thickness \n Endometrial echogenicity \n Uterine size and morphology \n Presence of leiomyoma \n Endometrial polyp \n Adenomyosis \n Endometrial hyperplasia \n Ovarian pathology \n Other pelvic abnormalities \n \nHistopathological examination of endometrial tissue , obtained \nby endometrial biopsy or hysterectomy wherever clinically \nindicated, was used as the reference standard for correlation. \n \nOutcome Measures \n Spectrum of abnormalities detected on TVUS. \n Measurement of endometrial thickness in women with \nAUB. \n Correlation of TVUS findings with histopathological \ndiagnosis where available. \n Diagnostic accuracy of TVUS in identifying ute rine \npathology. \n \nStatistical Analysis \nData were entered into Microsoft Excel and analyzed using IBM \nSPSS Statistics version 25.0. Continuous variables were \nexpressed as mean ± standard deviation , while categorical \nvariables were presented as frequencies an d percentages. \nAssociations between categorical variables were analyzed using \nthe Chi -square test or Fisher's exact test. The diagnostic \nperformance of TVUS was assessed by calculating sensitivity , \nspecificity, positive predictive value (PPV) , negative predictive \nvalue (NPV), and overall diagnostic accuracy. A p -value <0.05 \nwas considered statistically significant. \n \nResults \nA total of 150 women presenting with abnormal uterine bleeding \n(AUB) were included in the study. The mean age of the \nparticipants was 4 3.9 ± 9.6 years (range: 22 –68 years). The \nmajority of women belonged to the 41 –50 years age group \n(40.0%). Heavy menstrual bleeding was the most common \npresenting complaint. Transvaginal ultrasonography (TVUS) \ndetected structural uterine abnormalities in a  majority of \npatients, with leiomyoma being the most frequent finding. \nHistopathological correlation, wherever available, demonstrated \ngood diagnostic accuracy of TVUS for endometrial pathology. \n \nTable 1: Demographic and clinical characteristics of study participants \n(n = 150) \n \nVariable Number (n) Percentage (%) \nAge (years) \n21–30 18 12.0 \n31–40 42 28.0 \n41–50 60 40.0 \n>50 30 20.0 \nParity \nNulliparous 24 16.0 \nMultiparous 126 84.0 \nPresenting complaint \nHeavy menstrual bleeding 72 48.0 \nIntermenstrual bleeding 24 16.0 \nIrregular menstrual bleeding 30 20.0 \nPostmenopausal bleeding 24 16.0 \nMean age: 43.9 ± 9.6 years \n \nMost participants (40.0%) were aged 41 –50 years , and 84.0% \nwere multiparous. Heavy menstrual bleeding was the most \ncommon presenting complaint (48.0%), followed by irregular \nmenstrual bleeding (20.0%). \n \n \n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n~ 879 ~ \nTable 2: Transvaginal ultrasonography findings among women with \nabnormal uterine bleeding (n = 150) \n \nTVUS Finding Number (n) Percentage (%) \nLeiomyoma 48 32.0 \nEndometrial hyperplasia 28 18.7 \nAdenomyosis 20 13.3 \nEndometrial polyp 16 10.7 \nOvarian cyst 10 6.7 \nNormal study 22 14.6 \nOther pelvic pathology 6 4.0 \n \nLeiomyoma was the most common abnormality detected on \nTVUS (32.0%) , followed by endometrial hyperplasia (18.7%) \nand adenomyosis (13.3% ). Only 14.6% of women had normal \nultrasonographic findings. \n \nTable 3: Endometrial thickness according to age group (n = 150) \n \nAge Group Endometrial thickness <5 mm 5–10 mm >10 mm Total p-value \n21–30 years 2 12 4 18  31–40 years 6 26 10 42  41–50 years 8 30 22 60  >50 years 16 10 4 30  Total 32 78 40 150 0.018* \n*Chi-square test; p <0.05 considered statistically significant. \n \nWomen aged 41 –50 years had the highest proportion of \nendometrial thickness >10 mm, whereas women aged >50 years \npredominantly ha d endometrial thickness <5 mm. The \nassociation between age and endometrial thickness was \nstatistically significant (p = 0.018). \n \nTable 4: Diagnostic performance of transvaginal \nultrasonography for detecting endometrial pathology \n(Histopathology as reference standard) \n \nParameter Value (%) \nSensitivity 91.2 \nSpecificity 87.5 \nPositive Predictive Value (PPV) 88.6 \nNegative Predictive Value (NPV) 90.3 \nOverall Diagnostic Accuracy 89.3 \n \nTransvaginal ultrasonography demonstrated high diagnostic \nperformance in de tecting endometrial pathology , with a \nsensitivity of 91.2% , specificity of 87.5% , and an overall \ndiagnostic accuracy of 89.3%, indicating that TVUS is a reliable \nfirst-line imaging modality in the evaluation of abnormal uterine \nbleeding. \n \nDiscussion \nThe present prospective observational study evaluated the role of \ntransvaginal ultrasonography (TVUS) in women presenting with \nabnormal uterine bleeding (AUB). The majority of patients were \nin the 41–50 years age group, reflecting the increased frequency \nof AUB during the perimenopausal period due to hormonal \nfluctuations and structural uterine abnormalities. TVUS \nsuccessfully identified the underlying pathology in most \npatients, confirming its value as an effective first -line diagnostic \nmodality. \nLeiomyoma was t he most common ultrasonographic finding \n(32.0%), followed by endometrial hyperplasia and adenomyosis. \nThese findings are consistent with those reported by Dreisler et \nal., who demonstrated that TVUS accurately detects common \nstructural causes of AUB and as sists in selecting patients who \nrequire further invasive evaluation [10]. Similarly, Farquhar et al. \nobserved that endometrial hyperplasia is an important cause of \nabnormal uterine bleeding , particularly among women with \nincreased endometrial thickness and associated risk factors [11]. \nThe present study showed a significant association between \nincreasing age and endometrial thickness, with women aged 41–\n50 years exhibiting a higher frequency of endometrial \nthickening. These findings are in agreement with Wo lfman, who \nemphasized that measurement of endometrial thickness by \nTVUS is an important predictor of underlying endometrial \npathology and helps determine the need for endometrial \nsampling [12]. \nTVUS demonstrated high sensitivity (91.2%) , specificity \n(87.5%), and overall diagnostic accuracy (89.3%) for detecting \nendometrial pathology. Similar observations were reported by \nBradley and Gueye and Van den Bosch and Van Schoubroeck , \nwho concluded that TVUS provides excellent visualization of \nthe endometrium and m yometrium and significantly improves \nthe diagnostic evaluation of women with AUB [13, 14]. \nCurrent NICE guidelines recommend transvaginal \nultrasonography as the preferred initial imaging investigation for \nwomen with suspected structural causes of AUB becau se of its \nnon-invasive nature, accessibility, and high diagnostic accuracy. \nTimely diagnosis with TVUS facilitates appropriate \nmanagement and reduces unnecessary invasive procedures [15]. \n \nConclusion \nTransvaginal ultrasonography is a reliable , safe, and co st-\neffective first -line imaging modality for evaluating abnormal \nuterine bleeding. It accurately detects structural uterine \nabnormalities, assesses endometrial thickness , and demonstrates \nhigh diagnostic accuracy for identifying endometrial pathology. \nEarly use of TVUS enables appropriate clinical decision -\nmaking, guides the need for histopathological evaluation , and \ncontributes to improved patient management. \n \nConflict of Interest \nNot available  \n \nFinancial Support  \nNot available \n \nReferences \n1. Munro MG , Critchley HOD , Broder MS , Fraser IS; FIGO \nWorking Group on Menstrual Disorders. FIGO \nclassification system (PALM -COEIN) for causes of \nabnormal uterine bleeding in nongravid women of \nreproductive age. Int J Gynaecol Obstet. 2011;113(1):3 -13. \nDOI:10.1016/j.ijgo.2010.11.011 \n2. Munro MG , Critchley HOD , Fraser IS; FIGO Menstrual \nDisorders Committee. The FIGO classification of causes of \nabnormal uterine bleeding: revisions and updates. Int J \nGynaecol Obstet. 2018;143(3):393-408.  \nDOI:10.1002/ijgo.12666 \n3. 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Best Pract Res Clin Obstet \nGynaecol. 2011;25(5):633-644.  \nDOI:10.1016/j.bpobgyn.2011.05.009 \n15. National Institute for  Health and Care Excellence. Heavy \nmenstrual bleeding: assessment and management (NICE \nGuideline NG88). Published March 14, 2018. Updated May \n24, 2021. https://www.nice.org.uk/guidance/ng88 \n \n \nHow to Cite This Article \nPounikar M, Deshmukh S.  Role of Transv aginal Ultrasonography in the \nEvaluation of Abnormal Uterine Bleeding . International Journal of Clinical \nObstetrics and Gynaecology. 2026;10(4):877-880.  \n \n \nCreative Commons (CC) License \nThis is an open access journal , and articles are distributed under th e terms \nof the Creative Commons Attribution -Non-Commercial-Share Alike 4.0 \nInternational (CC BY -NC-SA 4.0) License , which allows others to remix , \ntweak, and build upon the work non -commercially, as long as appropriate \ncredit is given and the new creations are licensed under the identical terms.","source_license":"CC0","license_restricted":false}