Diagnostic Performance of Transvaginal Ultrasonography in Detecting Endometrial Pathology in Women with Postmenopausal Bleeding

Background: Postmenopausal bleeding (PMB) is a common yet concerning symptom often associated with endometrial pathology, including hyperplasia and carcinoma. Accurate, non-invasive, and accessible diagnostic tools are essential for early detection and appropriate management, especially in resource-limited settings like Bangladesh. Aim of the Study: The aim of this study was to evaluate the diagnostic performance of transvaginal ultrasonography in detecting endometrial pathology in women with postmenopausal bleeding. Methods: This cross-sectional study was conducted in Department of Obstetrics & Gynaecology at Dhaka Medical College Hospital, Dhaka, Bangladesh, during the period from June 2022 to May 2023. Total 65 menopausal women presenting with vaginal bleeding were included in this study. Result: The majority of women (78.5%) were between 45 and 60 years of age, with a mean age of 55.5 ± 7.6 years. Among the participants, 58.5% had an endometrial thickness >5 mm. Histopathological findings revealed that 70.8% had abnormal endometrial pathology, including hyperplasia (47.8%) and carcinoma (13.1%). An endometrial thickness cut-off of ≥4.99 mm showed a sensitivity of 82.61%, specificity of 73.68%, PPV of 88.37%, NPV of 63.64%, and overall accuracy of 80% in detecting any pathology. For detecting carcinoma, a threshold of ≥13.5 mm yielded 100% sensitivity and NPV, with an accuracy of 87.69%. Conclusion: TVS is a highly effective, non-invasive screening tool for evaluating endometrial pathology of women with postmenopausal bleeding and should be integrated into diagnostic protocols to reduce reliance on invasive procedures.