The Diagnostic Power of Ultrasound in Postmenopausal Bleeding

Ultrasonography has important implications for the selection of patients for whom biopsy curettage is considered necessary. One of the most common symptoms in gynaecology is abundant bleeding. In post-menopause, bleeding may occur in a number of pathologies such as: polyps, hyperplasia or cancer. The objective of the paper is to correlate the visualisation of the endometrial details (thickness and structure of the endometrium) and the selection of patients who benefit from endometrial biopsy. From an ultrasound point of view, endometrial hyperplasia is difficult to differentiate from endometrial cancer. Neoplasia is suggested by a thickness of the endometrium of over 10 mm and with an irregular contour. The discontinuity of the hypoechoic myometrium can be seen in advanced forms of endometrial cancer. Endometrial hyperplasia is characterized by diffuse thickening of the endometrium. Polyps are visualised as masses with increased echogenicity, which contrasts with the hypoechogenicity of the surrounding endometrium of the uterine cavity. The colour Doppler usually identifies a vascular pedicle. Transvaginal ultrasound allows the measurement of the thickness of the endometrium and the visualisation of its structure, thus helping decide which patients benefit the most from endometrial biopsy.