Uterine Cavity Assessment and Endometrial Hormonal Receptors in Women with Peri and Post-Menopausal Bleeding

Background: Abnormal uterine bleeding (AUB) is any heavy or unusual bleeding from the uterus (through your vagina). It can occur at any time during your monthly cycle, including during your normal menstrual period. Aim: This study aimed to compare the accuracy of TVUS and SIS in relation to hysteroscopy in assessing the uterine cavity and in detecting ER and PR in endometrium and their relation with endometrial polyps in women with peri and postmenopausal bleeding. Materials and methods: The present study was a prospective study which included 120 patients with AUB who were attending the department of gynaecology at Gandhi Medical College, Hyderabad from July 2012 to November 2015. Results: 120 patients were selected in this study. Patients suffering from endometrial polyp were 40 (33.34%), endometrial hyperplasia were 25 (20.83%), endometrial atrophy were 19 (15.83%), normal endometrium were 19 (15.83%) and submucous fibroid were 17 (14.17%). Age was shown in mean±SD and p-value was 0.39 and it was statistically non- significant. Parity was shown in mean±SD and p-value was 0.283 and it was statistically non-significant. SIS had 4 false negative results by missing 2 cases with endometrial polyps, 4 false positive result by diagnosing a case of 4 endometrial hyperplasia as polypi. SIS had 8 false negative results (by missing 6 cases), 8 false positive results (3 cases was found to have polypi and 5 cases were normal). Mean endometrial thickness in mm in various diagnosis by TVUS as follows; endometrial polyp had 15.49±10.98, endometrial hyperplasia had 8.19±5.55, endometrial atrophy had 4.55±2.97 and normal endometrium had 12.68±6.80. Conclusion: Especially with intra-cavitary lesions, sonohysterography is superior to ultrasound and very close to hysteroscopy. Hysteroscopy remains the reliable standard for uterine cavity assessment, but cannot replace the histopathology. In the pathogenesis of endometrial polyps and endometrial hyperplasia, the expression of endometrial steroid receptors is crucial.