Comparative Efficacy of Transvaginal Sonography & Hysteroscopy with Histopathology of Endometrium in Perimenopausal Abnormal Uterine Bleeding

Introduction: Abnormal uterine bleeding (AUB) encompasses any deviation from normal menstrual cycles and is a prevalent issue among reproductive-aged women, accounting for approximately 33% of gynecological referrals. The etiology of AUB is varied, ranging from anovulation and pregnancy to more severe causes like uterine pathologies and coagulopathies. Given the diverse causes, a meticulous diagnostic approach is vital for management. The PALM-COEIN classification aids in the systematic categorization of AUB causes into structural and non-structural factors, facilitating targeted diagnostic investigations. This study emphasizes the need for effective diagnostic tools such as transvaginal sonography (TVS) and hysteroscopy, which, despite their utility, have limitations in accurately distinguishing between different intrauterine pathologies. Aim & Objective: The primary aim of this study is to evaluate and compare the efficacy of TVS and hysteroscopy against histopathological examination for diagnosing AUB in perimenopausal women. Specific objectives include assessing the diagnostic capabilities of TVS and hysteroscopy in identifying endometrial lesions, comparing their findings, and determining their accuracy, sensitivity, specificity, and predictive values against histopathology. Methodology: This comparative cross-sectional study was conducted at LLRM Medical College, Meerut, over one year. A total of 172 perimenopausal women with symptoms of AUB were enrolled following ethical approval. Participants underwent detailed clinical evaluations, TVS, and hysteroscopy during the same menstrual cycle to assess endometrial conditions. Both diagnostic tools were evaluated against histopathological findings, serving as the gold standard. Data were analyzed for demographic variables, clinical symptoms, and diagnostic test performance using descriptive and inferential statistics. Result & Conclusion: The study's findings highlighted a mean participant age of 47.2 years with diverse socioeconomic backgrounds. Clinical presentations varied, with heavy menstrual bleeding being the most common symptom. Both TVS and hysteroscopy identified significant endometrial abnormalities, such as increased endometrial thickness and hyperplasia. However, hysteroscopy showed superior diagnostic accuracy, sensitivity, and specificity compared to TVS, particularly in confirming histopathological findings. The diagnostic yield of directed biopsies during hysteroscopy was notably higher than that of blind biopsies. These results underscore the higher reliability of hysteroscopy over TVS in diagnosing AUB, suggesting that while TVS is suitable for initial assessments, hysteroscopy provides a more definitive diagnostic approach, especially when TVS findings are inconclusive.