• Riffat Najeeb
  • Azra Saeed Awan
  • Umber Bakhtiar
  • Sadia Akhter


Background: Abnormal uterine bleeding (AUB) is a common problem which prompts morethan 20% of all visits to outpatient clinics, and may account for more than 25% of allhysterectomies. The objective of this study was to determine the role of transvaginalultrasonography in women of perimenopausal age group presenting with abnormal uterinebleeding. Methods: This descriptive study was conducted in Department of Obstructs andGynaecology, Railway General Hospital, Rawalpindi. One hundred and forty-one women whoattended the gynaecology clinic with abnormal uterine bleeding (menorrhagia, intermenstrualbleeding, or postcoital bleeding) between 40–47 years of age from January 2006 and April 2007were included in this study. The mean age was 44 years. Results: Among 141 womenendometrial lesions were detected in 77 cases on histopathology after Dialatation and Curettage(D&C), while 57 (40.42%) of these were confirmed on transvaginal ultrasongraphy as anendometrial pathology prior to this invasive procedure. Among the 64 remaining patients,showing normal proliferative endometrium on histopathology, 46 cases (71.87%) showed noabnormality on tranvaginal examination. Conclusion: Transvaginal sonography can be safelyused as an initial investigation in the management of abnormal uterine bleeding as it is a noninvasive procedure for the detection of endometrial pathology. The incidence of detection of anabnormal pathology by ultrasongraphy is high when focal lesions as fibroids, polyps or foreignbody is concerned. Dilatation and curettage being a blind procedure requires hospitalization andgeneral anaesthesia which can be safely replaced by an alternate valid, safe and non-invasivetechnique for evaluating the endometrial pathology in women of perimenopausal age group withabnormal uterine bleeding.Keywords: Abnormal Uterine Bleeding (AUB), Transvaginal Sonography (TVS), Dilatation andCurettage (D&C), Perimenopasual


Munro MG. Abnormal uterine bleeding in reproductive years.

Part II: Medical management. J Am Assoc. Gynecol Laparosc


Schappert SM. Ambulatory care visits to physician offices,

hospital outpatients and emergencydepartments: United States,

National Center for Health Statistics. Vital Health Statistics


McCluggage WG. My approach to the interpretation of

endometrial biopsies and curettings, J Clin Pathol


Munro MG. Abnormal uterine bleeding in reproductive years.

Part I .Pathogenesis and clinical investigations. J Am Assoc.

Gynecol Laparosc 1999;6:391–428.

Conoscenti G, Meir YJ, Fischer-Tamaro L, Maieron A, Natale R,

D'Ottavio G, et al. Endometrial assessment by transvaginal

sonography and histological findings after D&C in women with

postmenopausal bleeding. Ultrasound Obstet Gynecol


Bakour S, Khan S, Gupta JK. The risk of premalignant and

malignant pathology in endometrial polyps. Aca Obstet Gynecol

Scand 2000;79:317–20.

Kelly P, Dobbs S, McCluggage W. Endometrial hyperplasia

involving endometrial polyps: report of a series & discussion in

an endometrial biopsy specimen; BJOG 2007;114:944–50.

Grunfeld L, Walker B, Bergh PA, Sandler B, Hofmann G, Navot

D. High resolution endovaginal ultrasonography of the

endometrium: a noninvasive test for endometrial adequacy.

Obstet Gynecol 1991;78:200–4.

Smith P, Bakos O, Heimer G, Ulmsten U. Transvaginal

ultrasound for identifying endometrial abnormality. Acta Obstet

Gynae Scand 1991;70:591–4.

Bakos O, Heimer G. Transvaginal ultrasonographic evaluation of

endometrium related to histological findings in pre-ad perimenopausal women. Gynecol Obstet Invest 1998;45:199–204.

Dijkhuizen FP, Brolmann HA, Potters AE, Bongers MY, Heinz

AP. The accuracy of transvaginal ultrasonography in the

diagnosis of endometrial abnormalities. Obstet Gynecol


Emanuel MH, Warmstaker K, Lannes FB. A prospective

comparison of transvaginal sonography and diagnostic

hysteroscopy in evaluation of patients with abnormal uterine

bleeding. Am J Obstet Gynecol 1995;172:547–52.

Saha TK, Amer SA, Biss J, Thakare H, Williams S, Farrell CT,

Calvert J.. The validity of transvaginal ultrasound measurement

of endometrial thickness: a comparison of ultrasound

measurement with direct anatominal measurement. BJOG


Gvanberg S, Wikland M, Karlgson B, Norstrom A, Friberg LG.

Endometrial thickness as measurement by endometrial

ultrasonography for identifying endometrial abnormality. Am J

Obstet Gynaecol 1991;164:47–52.

J Ayub Med Coll Abbottabad 2010;22(1)

Spandorfer SD, Arrendondo-Soberon F, Loret de Mola JR,

Feringbang RF. Reliability of intraobserver and intraobserver

sonographic endometrial stripe thickness measurments. Fertil

Steril 1998;70:152–4.

Fleischer AC, Kalemeris GC, Machin JE, Entman SS, James

AE Jr. Sonographic depiction of normal and abnormal

endometrium with histopathologic correlation. J Ultrasound

Med 1986;5:445–52.

Smith Brindman R , Kerlikowske K, Felstein VA, Subak L,

Scheidler J, Segal M, et al. Endovaginal ultrasound to exclude

endometrial cancer and other endometrial abnormalities. JAMA


Karlsson B, Gvanberg S, Metal W. Ylöstalo P, Torvid K, Marsal

K, et al. Transvaginal ultrasonography of endometrium in

women with postmenopausal bleeding. a Nordic multi-centre

study. Am J Obstet Gynecol 1995;172:1488–94.

Di Naro E, Bratta FG, Romano F, Caradonna F, Loizzi P.

The diagnosis of benign uterine pathology using transvaginal

endohysterosonography. Clin Exp Obstet Gynecol


Delisle MF, Villeneuve M, Bonlvain M. measurement of

endometrial thickness with transvaginal ultrasonography: is it

reproducible? J Ultrasound Med 1998;17:481–4.

Langer RD, Pierce JJ, O’Hanlan KA, Johnson SR, Espeland MA,

Trabal JF, et al. Transvaginal ultrasonography compared with

endometrial biopsy for detection of endometrial disease. N Engl.

J. Med 1997;337:1792–8.