Role of Ultrasound in Women with Postmenopausal Bleeding

Background: Objectives of current study were to diagnose benign and malignant causes of abnormal uterine bleeding in postmenopausal women (PMW) by transvaginal ultrasound grey scale imaging and power doppler, thereby minimizing unnecessary interventions in the form of operations and hysteroscopy where sonography findings are normal. Methods: After obtaining ethical clearance present prospective observational study was conducted from October 2019 to October 2020, to evaluate the endometrium in 75 postmenopausal women (PMW) with bleeding per vagina referred to the department of Radio diagnosis in Rajah Muthiah Medical and Hospital. After applying inclusion and exclusion criterias, the cases were evaluated with ultrasonography both transabdominal (TAS) and transvaginal scan (TVS) with power doppler. Histopathological correlation was done in all cases. Results: Our study shows majority (37.3%) of the women with postmenopausal bleed were in the age group of 50-54 years. Most common causes of PMB were atrophic endometrium (41.3%), Ca cervix (22.7%), Endometrial carcinoma (5.3%), Endometrial Hyperplasia (4%), endometrial polyp (2.7%), followed by fibroid (1.3%) in this study. Diagnostic capacities of Endometrial thickness with Endometrial characteristics, Endometrial Echo and Power Doppler was statistically calculated. Sensitivity, specificity, positive predictivity and negative predictivity value of Endometrial characteristics and echo were 85.7.0%, 94.1%, 60.0% and 98.5% respectively. Sensitivity, specificity, positive predictivity, negative predictivity value of Power Doppler were 100.0%, 91.5%, 40.0% and 100.0% respectively . Conclusions: In women with AUB in postmenopausal age ultrasonography (USG) can be considered as an initial imaging modality for diagnosing endometrial diseases. TVS yields high accuracy in differentiating benign from malignant condition when combining endometrial thickness with endometrial characteristics, endometrial echo and power Doppler thus reducing the need for invasive procedure like biopsy.