The Diagnostic Role of Office Hysteroscopy and Three-Dimensional Transvaginal Ultrasonography in Evaluation of Women with Abnormal Uterine Bleeding

Abstract

Background: Abnormal uterine bleeding (AUB) is common and can cause a massive impact on women’s physical, social and emotional wellbeing.

Purpose: To determine the role of office hysteroscopy (OH) and three-dimensional (3D) transvaginal ultrasonography (TVS) in women with AUB.

Methods: 80 women were evaluated. Hemodynamic instability, severe anemia, coagulation and bleeding disorders, cervical lesions or cancer, virgins and pregnant women were excluded. 3D TVS and OH were used.

Results: When OH detected polyp, 50% were diagnosed with polyp by 3D TVS, 10% thickened endometrium, 10% with fibroid and adenomyosis. TVS detected no pathology in 30% of cases. When OH detected fibroid and thickened endometrium, 3D TVS detected thickened endometrium. Niche was detected equally. When OH diagnosed fibroid, 30% were diagnosed as polyp and fibroid by 3D TVS, 70% had the same diagnosis. When OH diagnosed thickened endometrium, 27.3% were diagnosed as polyp by 3D TVS, 36.4% as fibroid, 36.4% as thickened endometrium. When OH detected no pathology, 16.7 percent were diagnosed as polyp associated with fibroid and adenomyosis by 3D TVS, 50% as adenomyosis. In 33.3% patients, 3D TVS diagnosed no pathology.

Conclusion: According to this study, 3D TVS is relatively inexpensive and time saving with high reliability. Thus, routine use of 3D TVS to evaluate the endometrial cavitary lesions or abnormalities before invasive procedures such as OH is rational. OH, allows direct visualization of the uterine cavity and can detect small localized lesions missed by TVS, especially polypi. Moreover, it has the advantage of simultaneous treatment or biopsy.