Transvaginal Sonography And Histopathological Correlation Of Endometrial Pathology In Women With Postmenopausal Bleeding: A Cross-Sectional Observational Study

Abstract

Background: Postmenopausal bleeding (PMB) is a sentinel symptom that requires careful evaluation, as up to 10% of cases may signify endometrial carcinoma. Transvaginal sonography (TVS) is the first-line imaging modality used to assess endometrial thickness (ET), offering a non-invasive and cost-effective triage tool before histopathological confirmation.

Objective: To determine the diagnostic accuracy of endometrial thickness measured on TVS in predicting endometrial pathology and to correlate ET values with histopathological examination (HPE) and clinical risk factors among postmenopausal women presenting with bleeding.

Methods: This cross-sectional study involved 35 postmenopausal women with PMB who underwent TVS followed by endometrial sampling through hysteroscopy-guided biopsy, dilatation and curettage, or Pipelle aspiration. Clinical parameters, including age, BMI, age at menarche and menopause, and comorbidities (hypertension, diabetes), were recorded. Statistical associations were tested using Chi-square, Fisher’s exact, and non-parametric tests, with p < 0.05 considered significant.

Results: The mean age of participants was 59.4 years, and 77.1% were overweight or obese. The most common histopathological finding was benign endometrial polyp (42.9%), followed by hyperplasia without atypia (11.4%), hyperplasia with atypia (5.7%), and adenocarcinoma (14.3%). All cases of hyperplasia and carcinoma occurred with ET > 4 mm, while ET ≤ 4 mm corresponded exclusively to atrophic or basal endometrium (p = 0.003). The diagnostic accuracy of ET > 4 mm for predicting hyperplasia or carcinoma demonstrated sensitivity 100%, specificity 20.8%, PPV 36.7%, and NPV 100%. Significant correlates of endometrial pathology included age 56–65 years, BMI ≥ 25 kg/m², hypertension, diabetes, early menarche, and late menopause (p < 0.05).

Conclusions: An endometrial thickness threshold of 4 mm on TVS remains a highly sensitive criterion for excluding malignancy in PMB. Integration of metabolic and reproductive risk factors—particularly obesity, hypertension, and diabetes—further refines diagnostic accuracy. A two-tier diagnostic approach combining TVS and targeted endometrial biopsy optimizes early detection and management of endometrial pathology in postmenopausal bleeding.