WS04: Menopausis WS04‐01Transvaginal sonography of the endometrium and sonohysterography in the menopause

Background All endometrial sampling methods are invasive. Therefore in sympyomatic women and for women at risk of developing endometrial pathology in menopause a technique that could reduce the number of biopsy procedures would be of a great value. This technique would be relatively non‐invasive, easy to learn and perform, cost effective and well accepted by the patients. The objective of this study was the assessment of the diagnostic potency of ultrasound measurements by comparison with the usual histological investigation. Method Endovaginal ultrasonography (measurement of endometrial thickness and morphology of endometrium) prior to endometrial sampling was done in 160 postmenopausal patients. 143 D&C, 15 hysteroscopies and 2 laparotomies were performed to collect endometrial tissue. Indications for endometrial sampling were bleeding in 72%, ultrasound suspicion of endometrium in 18%, or other (cervical or adnexal pathology) in 10% of patients. Sonohysterography, as an improvement over conventional ultrasound methods, was done in 12 cases (7.5%). Pathologic findings were compared to preoperative ultrasonography. Results Ultrasound measurement of endometrial thickness combined with morphology and sonohysterography detected more than 90% endometrial pathology (sensitivity 96%, specificity 92%). Conclusion We found endovaginal ultrasound as useful tool at identifying endometrial diseases in menopause. For a postmenopausal woman with vaginal bleeding with a 10% pretest probability of endometrial cancer, her probability of cancer is less than 1% following a normal endovaginal sonography and sonohysterography. Ultrasound should be considered as investigational and cannot be used as the only methods to evaluate abnormal bleeding in menopausal patients.