Objective:

To investigate the role of ultrasonography and office hysteroscopy in the diagnosis of endometrial status with the correlation of histopathologic findings in symptomatic and asymptomatic group of menopausal patients with hormone replacement therapy (HRT) users and non users.

Material and Methods:

Asymptomatic 80 patients with abnormal endometrial thickness and 70 patients with postmenopausal uterine bleeding were undergone office hysteroscopy. Endometrial thickness was diagnosed as abnormal with more than 8 milimeters in HRT users and 5 milimeters in non-users respectively. All 150 patients were evaluated with office hysteroscopy. Endometrial sampling was carried out in all cases. Transvaginal ultrasonograpy and office hysteroscopy procedures were correlated with the histopathologic findings.

Results:

96 of the patients (64%) were not using HRT and 54 of them (36%) were using HRT. 80 (53.3%) of the patients were asymptomatic while 70 (46.7%) of them were symptomatic. Transvaginal ultrasonograpy were normal in 28.7% of the patients. Abnormal thickness of the endometrium was found in 55.3% of cases. At hysteroscopic evaluation 15.3% of the patients were normal. Endometrial polyp (27.3%) was the most significant abnormal finding. Endometrial polyp (51.3%) was the most significant hystopathologic diagnosis in the asymptomatic group while 14.3% of cases had hyperplasia and 34.3% of cases atrophic endometrium was found in the symptomatic group. Endometrial hyperplasia was diagnosed at 3 asymptomatic and 10 symptomatic patients. Over all predictivity of office hysteroscopy for endometrial hyperplasia was 58.8%. Asymptomatic patients were non HRT users and hysteroscopic finding was endometrial polyp in all cases. Endometrial thickness was all abnormal in symptomatic patients. Hysteroscopic diagnosis was hyperplastic endometrium in all of the cases.

Conclusion:

Endometrial polyps are the most common finding at hysteroscopy in asymptomatic patients with abnormal endometrial thickness in transvaginal ultrasonograpy. Office hysteroscopy is highly sensitive in symptomatic patients though false negative diagnosis such as polyps is common in asymptomatic patients and endometrial biopsy is still indicated in patients with abnormal endometrial thickness in transvaginal ultrasound.

Keywords: Transvaginal ultrasonography, office hysteroscopy, menopause