ULTRASONOGRAPHIC EVALUATION OF ENDOMETRIAL THICKNESS AND PATTERN IN ABNORMAL UTERINE BLEEDING.

Abstract

Background: Abnormal uterine bleeding (AUB) is a common gynecologic problem where early identification of endometrial pathology is important, especially in perimenopausal and postmenopausal women. Transvaginal ultrasound (TVUS) is widely used as a first-line test to assess endometrial thickness (ET) and detect structural causes that may require further evaluation. ​

Methods: A cross-sectional observational study was conducted among 130 women (≥18 years) presenting with AUB, excluding pregnancy, prior malignancy, and recent hormone use. All participants underwent TVUS with ET measurement and endometrial pattern assessment, and endometrial sampling/hysteroscopy was performed when indicated by clinical or sonographic suspicion.

Results: Mean age was 41.8 ± 10.6 years; 61.5% were reproductive age, 23.1% perimenopausal, and 15.4% had postmenopausal bleeding. On TVUS, perimenopausal women more commonly had ET >12 mm (46.7%), while 50% of postmenopausal bleeders had ET >4 mm; predominant patterns were homogeneous (46.2%), heterogeneous (32.3%), cystic (13.8%), and focal lesions (7.7%). Final diagnoses were benign/normal in 42.3%, polyps in 15.4%, hyperplasia without atypia in 13.8%, EIN/atypical hyperplasia in 4.6%, and carcinoma in 3.1%, with higher mean ET in premalignant/malignant categories.

Conclusion: TVUS-based assessment of ET together with standardized morphological descriptors provides a practical triage approach in women with AUB to identify those needing biopsy or hysteroscopy while avoiding unnecessary invasive testing in low-risk cases. These findings support continuing TVUS as the initial imaging modality in AUB evaluation, with escalation based on risk profile and suspicious ultrasound features.