THE IDEAL INVESTIGATIVE METHOD FOR EVALUATION OF ABNORMAL UTERINE BLEEDING IN PERI AND POST MENOPAUSAL WOMEN

CORRESPONDING AUTHOR:
Dr. Poushali Sanyal,
192/A, Shyama Prasad,
 Mukherjee Road, Kolkata-700026
E-mail: poushali.sanyal@yahoo.co.in

ABSTRACT: AIM: The study was designed to compare the accuracy of trans vaginal sonography, hysteroscopy, and histo pathological examination of endometrium after Dilatation & Curettage in cases of abnormal uterine bleeding, to detect different aetiology of abnormal uterine bleeding in these women and to formulate the ideal investigation of abnormal uterine bleeding in these women. METHODS: A total of 70 peri menopausal and postmenopausal women with abnormal uterine bleeding were taken into the study. After thorough history and clinical examination, the patient was sent for trans vaginal ultra sonographic assessment, followed by a hysteroscopy & dilatation and curettage done as an indoor procedure with a 30 degree rigid hysteroscope (Carl storz) with a 5 mm sheath. The endometrium was sent for histopathology. Diagnosis according to all the three modalities were compared and evaluated. RESULTS: While comparing between TVS and hysteroscopy in total study group taking hysteroscopy as standard, TVS showed a good sensitivity of 85.7% while specificity of 56.5 %. Whereas, during comparison between D & C and hysteroscopy in total study population taking hysteroscopy as standard, sensitivity of D & C came out to be 61.9% while specificity was 88.9%. This shows that D & C is missing a high percentage of cases. There was a fair strength of agreement between hysteroscopy and TVS. There was a moderate strength of agreement between hysteroscopy and Dilatation & curettage. CONCLUSION: TVS is more sensitive in diagnosing cases of fibroids mainly intramural and subserous ones which are missed by hysteroscopy. According to our study it can be concluded that TVS can be taken up as a first line of investigation since it is highly sensitive followed by hysteroscopic guided biopsy.

KEYWORDS: Transvaginal sonography, Hysteroscopy, abnormal uterine bleeding.