Use of Ultrasonohysterography for Triage of Perimenopausal Patients With Unexplained Uterine Bleeding

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Concerns about pathologic anatomy in perimenopausal women with irregular vaginal bleeding have made invasive diagnostic procedures commonplace. This study evaluated the use of fluid instillation to enhance vaginal probe ultrasonographic examination of the endometrium in such patients.


This was a prospective study of 21 women between 40 and 52 years old with irregular vaginal bleeding. On day 4 to 6 of the menstrual cycle a 5.3F Soules intrauterine insemination catheter (Cook ObGyn, Spencer, Ind.) was inserted, and under direct ultrasonographic examination sterile saline solution was slowly infused. If present, any polyp or submucous myoma was noted and the endometrial thickness surrounding the fluid was measured. Invasive endometrial sampling was then carried out.


Of the 21 patients, 8 had obvious polypoid lesions and underwent triage for operative hysteroscopic removal. The pathology report confirmed benign polyps in all 8. Three patients had submucous myomas. Two had wire loop resectoscopic excision. The third, with a submucous myoma that extended to the serosal edge of the uterus, received expectant management. Nine patients had no obvious anatomic lesion and endometrial thickness of <=4 mm. Biopsy in all 9 of these patients revealed early proliferative endometrium. One patient had endometrial thickness of 8 mm; fractional curettage with hysterectomy revealed simple hyperplasia without atypia.


Endometrial fluid instillation to enhance vaginal ultrasonography in perimenopausal women can reliably distinguish between patients with minimal tissue whose bleeding may be of anovulatory origin and best treated with hormonal therapy and those patients with significant amounts and type of tissue in need of formal curettage. Furthermore, polyps may be distinguished from submucous myomas, which allows appropriate preoperative triage for operative hysteroscopy when indicated and eliminates the need for diagnostic hysteroscopy. (AM J OBSTET GYNECOL 1994;170:565-70.)

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