Les ménorragies après 40 ans. Apport des examens ultrasonores

Menorrhagia after age 40 can have functional, general, local, or organic reasons. The most frequent are: submucous myomas, adenomyosis, polyps. Submucous myomas: a transvaginal scan (TVUS) specifies the type of myoma according to its situation within the uterine cavity: intracavitary myoma or submucous. A transvaginal scan is performed to assess myomas before operative HSC. There are three criteria to check: myomas diameter must be less than 5 cm; 5 mm or more of normal myometrium should be present between myoma and external wall; the myoma must not be in contiguity with a subserosal myoma. Uterine adenomyosis is a common gynecologic condition that is characterized by the presence of heterotopic endometrial glands and stroma in the myometrium with adjacent smooth muscle hyperplasia. Pathology may be proximal or distal, focal or diffuse. Transvaginal US shows: cystic dilatation of heterotopic glands, heterogeneity of the myometrial echotexture, antero-posterior asymmetry of the uterus. TVUS has a sensitivity of 62 to 89% and a specificity of 89 to 96%. Polyps are most often hyperechoic: this makes the diagnosis more difficult in luteal phase; Power Doppler shows the vascular central pedicle. TVUS has a sensitivity of 75%. The polyps smaller than 3 mm are not visible in a reliable way without the help of a contrast media in the cavity.