Transvaginal ultrasonography versus hysteroscopy in endometrial pathology diagnosis among women with abnormal uterine bleeding
DISCOVERIES REPORTS (ISSN 2393249X), 2021, volume 4

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CITATION: Vijayan R, Kamath R, Pandav K, Mehendale M. Transvaginal ultrasonography versus hysteroscopy in endometrial pathology diagnosis among women with abnormal uterine bleeding. Discoveries Reports 2021; 4(3): e24. DOI: 10.15190/drep.2021.9  Submitted: July 12, 2021; Revised: Dec. 19. 2021; Accepted: Dec. 23, 2021; Published: Dec. 31, 2021.

Transvaginal ultrasonography versus hysteroscopy in endometrial pathology diagnosis among women with abnormal uterine bleeding 

Rupalakshmi Vijayan (1,*), Rajalakshmi Kamath (1), Krunal Pandav (2), Meghana Mehendale (2)

(1) Department of Obstetrics and Gynecology, Kasturba Medical College, Mangaluru, Karnataka, India
(2) Department of Internal Medicine, Smolensk State Medical University, Smolensk, Smolensk Oblast, Russia 

* Corresponding author: Rupalakshmi Vijayan, M.D., Department of Obstetrics and Gynecology, Kasturba Medical College, Light House Hill Road, Hampankatta, Mangaluru, Karnataka 575001, India; Email:


Objective: Abnormal uterine bleeding is any deviation from a normal menstrual pattern. Transvaginal ultrasonography is useful in determining endometrial thickness but cannot conclusively exclude sessile and pedunculated lesions. Hysteroscopy is an invasive procedure that detects discrete lesions. This study was aimed to evaluate the diagnostic accuracy of 2-dimensional transvaginal ultrasonography and hysteroscopy in evaluating endometrial lesions in women with abnormal uterine bleeding, by determining the sensitivity and specificity of the two methods in diagnosing the lesions.
Methods: Eighty-four cases of abnormal uterine bleeding were chosen based on inclusion criteria. The patients were subjected to routine investigations. The findings of transvaginal ultrasonography, hysteroscopy, and dilatation and curettage were compared and analyzed.
Results: Maximum incidence of abnormal uterine bleeding was observed in women between 41 and 50 years of age (73.8%). The most common presenting complaint was menorrhagia (76.1%). 76% of patients experienced symptoms for less than six months. The sensitivity and specificity of transvaginal ultrasonography were 60% and 96.3%, respectively. The sensitivity and specificity of hysteroscopy were 80.4% and 93.1%, respectively. The accuracy of transvaginal ultrasonography was 60.3%, and that of hysteroscopy was 83.3%.
Conclusion: Transvaginal ultrasonography and hysteroscopy can be used as first-line diagnostic modalities to rule out and find the causes of abnormal uterine bleeding, which can aid in instituting prompt and appropriate medical treatment.


1. Narice BF, Delaney B, Dickson JM. Endometrial sampling in low-risk patients with abnormal uterine bleeding: a systematic review and meta-synthesis. BMC Family Practice. 2018;19(1):135. doi:10.1186/s12875-018-0817-3
2. Davis E, Sparzak PB. Abnormal Uterine Bleeding. StatPearls Publishing; 2021. Accessed April 28, 2021.
3. Critchley HOD, Babayev E, Bulun SE, et al. Menstruation: science and society. American Journal of Obstetrics and Gynecology. 2020;223(5):624-664. doi:10.1016/j.ajog.2020.06.004
4. Matteson KA, Raker CA, Clark MA, Frick KD. Abnormal uterine bleeding, health status, and usual source of medical care: Analyses using the medical expenditures panel survey. Journal of Women’s Health. 2013;22(11):959-965. doi:10.1089/jwh.2013. 4288
5. Uterine Bleeding: Abnormal Uterine Bleeding | Cleveland Clinic. Accessed June 22, 2021.
6. Kolhe S. Management of abnormal uterine bleeding – focus on ambulatory hysteroscopy. International Journal of Women’s Health. 2018;10:127-136. doi:10.2147/IJWH.S98579
7. ACOG Committee Opinion No. 734: The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Women With Postmenopausal Bleeding. Obstetrics and gynecology. 2018;131(5): e124-e129. doi:10.1097/AOG.0000000000002631
8. NICE. Heavy menstrual bleeding: assessment and management (CG44). Nice. 2007;(January). Accessed June 22, 2021.
9. Nijkang NP, Anderson L, Markham R, Manconi F. Endometrial polyps: Pathogenesis, sequelae and treatment. SAGE Open Medicine. 2019;7:205031211984824. doi:10.1177/2050312119848247
10. Nayak B, Parida S, Rautray PN, Mohapatra J, Samantaray S, Giri SK. Transvaginal Sonography (TVS) in Evaluation of Endometrial Carcinoma and Its Correlation with Histopathology: A Retrospective Analysis. Indian Journal of Gynecologic Oncology. 2017;15(1):12. doi:10.1007/s40944-016-0095-8
11. Khafaga A, Goldstein SR. Abnormal Uterine Bleeding. Obstetrics and Gynecology Clinics of North America. 2019;46(4):595-605. doi:10.1016/j.ogc. 2019.07.001
12. van Trotsenburg M, Wieser F, Nagele F. Diagnostic hysteroscopy for the investigation of abnormal uterine bleeding in premenopausal patients. Contributions to gynecology and obstetrics. 2000;20:21-26. doi:10.1159/000060284
13. Panda A, Parulekar S, Gupta A. Diagnostic hysteroscopy in abnormal uterine bleeding and its histopathological correlation. The Journal of Obstetrics and Gynecology of India. 1999;175:74-76. doi:10.21276/obgyn.2021.7.2.24
14. Munro MG, Critchley HOD, Fraser IS. The FIGO classification of causes of abnormal uterine bleeding. International Journal of Gynecology and Obstetrics. 2011;113(1):1-2. doi:10.1016/j.ijgo.2011.01.001
15. Tsuda H, Ito YM, Todo Y, et al. Measurement of endometrial thickness in premenopausal women in office gynecology. Reproductive medicine and biology. 2018;17(1):29-35. doi:10.1002/rmb2.12062
16. Özdemir S, Çelik Ç, Gezginç K, KIreşi D, Esen H. Evaluation of endometrial thickness with transvaginal ultrasonography and histopathology in premenopausal women with abnormal vaginal bleeding. Archives of Gynecology and Obstetrics. 2010;282(4):395-399. doi:10.1007/s00404-009-1290-y
17. Dueholm M, Hjorth IMD. Structured imaging technique in the gynecologic office for the diagnosis of abnormal uterine bleeding. Best Practice and Research: Clinical Obstetrics and Gynaecology. 2017;40:23-43. doi:10.1016/j.bpobgyn.2016.09.010
18. Erdem M, Bilgin U, Bozkurt N, Erdem A. Comparison of transvaginal ultrasonography and saline infusion sonohysterography in evaluating the endometrial cavity in pre- and postmenopausal women with abnormal uterine bleeding. Menopause (New York, NY). 2007;14(5):846-852. doi:10.1097/gme. 0b013e3180333a6b
19. Wamsteker K. Hysteroscopy in the management of abnormal uterine bleeding. In: Siegler AM, Lindeman HJ, eds. Hysteroscopy: Principles and Practice. 1st ed. JB Lippincott; 1983:128-131.
20. Goyal BK, Gaur CI, Sharma GCS, Saha MA, Das NK. Transvaginal sonography versus hysteroscopy in evaluation of abnormal uterine bleeding. Medical Journal Armed Forces India. 2015;71(2):120-125. doi:10.1016/j.mjafi.2014.12.001
21. Vitner D, Filmer S, Goldstein I, Khatib N, Weiner Z. A comparison between ultrasonography and hysteroscopy in the diagnosis of uterine pathology. European journal of obstetrics, gynecology, and reproductive biology. 2013;171(1):143-145. doi:10.1016/j.ejogrb.2013.08.024
22. Grimbizis GF, Tsolakidis D, Mikos T, et al. A prospective comparison of transvaginal ultrasound, saline infusion sonohysterography, and diagnostic hysteroscopy in the evaluation of endometrial pathology. Fertility and sterility. 2010;94(7):2720-2725. doi:10.1016/j.fertnstert.2010.03.047
23. Mathew M, Gupta R, Krolikowski A. Role of transvaginal ultrasonography and diagnostic hysteroscopy in the evaluation of patients with abnormal uterine bleeding. International Journal of Gynecology & Obstetrics. 2000;71(3):251-253. doi:10.1016/S0020-7292(00)00272-1
24. Epstein E, Ramirez A, Skoog L, Valentin L. Transvaginal sonography, saline contrast sonohysterography and hysteroscopy for the investigation of women with postmenopausal bleeding and endometrium > 5 mm. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2001;18(2):157-162. doi:10.1046/j.1469-0705.2001. 00472.x
25. Kelekci S, Kaya E, Alan M, Alan Y, Bilge U, Mollamahmutoglu L. Comparison of transvaginal sonography, saline infusion sonography, and office hysteroscopy in reproductive-aged women with or without abnormal uterine bleeding. Fertility and sterility. 2005;84(3):682-686. doi:10.1016/j.fertnstert. 2005.03.036
26. Barati M, Masihi S, Moramezi F, Salemi S. Office Hysteroscopy in Patients with Abnormal Uterine Bleeding and Normal Transvaginal Sonography. International Journal of Fertility and Sterility. 2008;1(4):175-178. doi:10.22074/IJFS.2007.46212.
27. El-tabbakh BMN, Slamka P. Transvaginal Sonohysterography (Tv-Sh), Versus Hysterosalpingography (Hsg) And Laparoscopy | OBGYN.Net. Published online 2011:1-11. Accessed April 17, 2021. view/transvaginal-sonohysterography-tv-sh-versus-hysterosalpingography-hsg-and-laparoscopy
28. Goyal BK, Gaur I, Sharma S, Saha A, Das NK. Transvaginal sonography versus hysteroscopy in evaluation of abnormal uterine bleeding. Medical journal, Armed Forces India. 2015;71(2):120-125. doi:10.1016/j.mjafi.2014.12.001
29.    Tsonis O, Gkrozou F, Dimitriou E, Paschopoulos M. Comparative retrospective study on transvaginal sonography versus office hysteroscopy in the diagnosis of endometrial pathology among different subgroups. Journal of Obstetrics and Gynaecology Research. 2021;47(2):669-678. doi:10.1111/jog.1458085.