Peri- and Postmenopausal Uterine BleedingTransvaginal Ultrasound withHysterosonography and Diagnostic Correlationwith Hysteroscopy

The recent years have seen medical science and technology expand by leaps and bounds. We have shifted focus from correction of theproblem to prevention of the problem. Abnormal uterine bleeding is an important cause of ill health in perimenopausal women.In theperimenopausal years, there is an increase in the incidence of bleeding irregularities. This is because of an increase in the prevalence ofbenign and malignant uterine lesions. There has also been a significant increase in the number of women presenting with postmenopausalbleeding. At transvaginal ultrasonography (TVS), the finding of a thickened central endometrial complex, with or without cystic changes, isoften nonspecific and may be caused by an endometrial polyp, submucosal fibroid, endometrial hyperplasia, carcinoma or cystic atrophy.In addition, because of an increased prevalence of adenomyosis or adenomyosis-like changes in women around this age group, propertransvaginal sonographic assessment of endometrial thickness and abnormalities is of utmost importance but maybe difficult in somewomen.When TVS cannot accurately measure the endometrial thickness or when there is a nonspecific thickened central endometrial complex,hysterosonography can provide additional information and can help in the diagnosis and final treatment. Hysterosonography, as an adjunctto TVS, allows identification of intracavitary lesions and focal and diffuse endometrial abnormalities and helps determine the abnormality.Final diagnosis confirmed by hysteroscopy. In this review, we discuss these common abnormalities and the correlation of TVS andhysterosonographic findings with hysteroscopic evaluation.