Can vaginal ultrasound replace diagnostic curettage in the detection of endometrial pathology in post-menopausal bleeding?

  • Media Ghazi Sedeq Department of Surgery, College of Medicine, Hawler Medical University, Erbil, Iraq.
  • Shawnam Nasih Dawood Department of Surgery, College of Medicine, Hawler Medical University, Erbil, Iraq.
  • Aska Farooq Department of Surgery, College of Medicine, Hawler Medical University, Erbil, Iraq.
  • Shahla K. Alalaf epartment of Obstetrics and Gynaecology, College of Medicine , Hawler Medical University, Erbil, Iraq.
Keywords: Transvaginal ultrasound, Postmenopausal bleeding, Endometrial pathology


Background and objective: Post-menopausal bleeding due to endometrial abnormalities is a common diagnostic challenge facing the ultrasonogists and referring gynecologists. This study aimed to detect the validity of transvaginal ultrasound to detect endometrial pathologies and its sensitivity and specificity for determining endometrial carcinoma in women with postmenopausal bleeding.

Methods: A diagnostic accuracy study of transvaginal ultrasound and diagnostic curettage was conducted for evaluation of endometrial pathology in the College of Medicine, Hawler Medical University from October2016to January 2018. The sample size included 55 women with post-menopausal vaginal bleeding. The ultrasound findings were compared with histopathological results of endometrial biopsy.

Results: Out of 55 women, 49.09% had endometrial atrophy, 29.09% had endometrial hyperplasia, 16.36% had endometrial polyp, 3.64% had endometrial carcinoma, and 1.82% had hyperplasia with atypia according to histopathological findings. The sensitivity of ultrasound in detecting cancer was 66.7%, the specificity was 100%, the positive predictive value (PV) was 100%, and the negative predictive value was 98.1%. The total agreement rate was 98.2%.

Conclusion: Transvaginal ultrasound is an excellent diagnostic tool to determine whether further investigation with histopathological examination of endometrial biopsy is necessary for postmenopausal vaginal bleeding.


Breijer MC, Timmermans A, van Doorn HC, Mol BWJ, Opmeer BC. Diagnostic Strategies for Postmenopausal Bleeding. Obstet Gynecol Int 2010; 2010:850812.

Menopause: Overview. Eunice Kennedy Shriver National Institute of Child Health and Human Development. 28 June, 2013. (Accessed on October 11, 2017, at

Munot S, Lane G. Modern management of postmenopausal bleeding. Trends Urology, Gynecol. Sexual Health 2008; 13:20–4.

Moodley M, Roberts C. Clinical pathway for the evaluation of postmenopausal bleeding with an emphasis on endometrial cancer detection. J Obstet Gynaecol 2004 ; 24(7):736–41.

Astrup K, Olivarius NDF. Frequency of spontaneously occurring postmenopausal bleeding in the general population. Acta Obstet Gynecol Scand 2004; 83(2):203–7.

Nalaboff KM, Pellerito JS, Ben-Levi E. Imaging the endometrium: disease and normal variants. Radio graphics 2001; 21:1409–24.

Clark TJ, Barton PM, Coomarasamy A, Gupta JK, Khan KS. Investigating postmenopausal bleeding for endometrial cancer: cost-effectiveness of initial diagnostic strategies. BJOG 2006; 113(5)502–10.

Sanders RC, Winter TC. Clinicalsonography a practical guide. 4th ed. LWW; 2007. P. 313–4.

Smith-Bindman R, Weiss E, Feldstein V; How thick is too thick? When endometrial thickness should prompt biopsy in postmenopausal women without vaginal bleeding. Ultrasound Obstet Gynecol 2004; 24(5):558–65.

Sahdev A. Imaging the endometrium in postmenopausal bleeding. BMJ 2007; 334(7594):635–6.

Gerber B, Krause A, Muller H, Reimer T, Kulz T, Makovitzky J, et al. Effects of adjuvant tamoxifen on the endometrium in postmenopausal women with breast cancer: a prospective long-term study using transvaginal ultrasound. J Clin Oncol 2000; 18:3464–70.

Otify M, Fuller J, Ross J, Shaikh H, Johns J. Endometrial pathology in the postmenopausal woman – an evidence based approach to management. TOG 2015; 17(1):29–38.

Timmerman D, Verguts J, Konstantinovic ML, Moerman P, Van Schoubroeck D, Deprest J, et al. The pedicle artery sign based on sonography with color Doppler imaging can replace second-stage tests in women with abnormal vaginal bleeding. Ultrasound Obstet Gynecol 2003; 22:166–71.

Parkin DM, Bray F,Ferlay J, PisaniP. Estimating the world cancer burden: Globocan 2000. Int J Cancer 2001; 94(2):153–6.

Timmermans A, Opmeer BC, Veersema S, Mol BW. Patient performances in the evaluation of the postmenopausal bleeding. BJOG 2007; 114(9):1146–9.

El-Mowafi D, Farid A, El-Badawi A. Transvaginalsonography and Hysterescopy Versus Histopathology in postmenopausal Bleeding Obstetrics and Gyenecology, Radiology and Pathology Departments, Benha Faculty of Medicine Egypt 2005. (Accessed November 11, 2017, at

ACOG Committee Opinion No. 440: The Role of Transvaginal Ultrasonography in the Evaluation of Postmenopausal Bleeding. Obstet Gynecol 2009; 114(2):409–11

Sonali R, Sangeeta K , Manisha K . Histopathological evaluation in women with postmenopausal bleeding and associated risk factors for endometrial carcinoma. JEMDS 2013; l2(24):4397–02

Tsikouras P, Galazios G, Liberis V, Bouzaki A, Grapsas X, Maroulis G. TV sonographic assessment in postmenopausal asymptomatic women. Eur J Gynaecol Oncol 2007; 28(6):473–6.

Ozer A, Ozer S, Kanat-Pektas M. Correlation between transvaginal ultrasound measured the endometrial thickness and histopathological findings in Turkish women with abnormal uterine bleeding. J Obstet Gynaecol 2016; 42(5):573–8.

Memon F, Munwar R Rajpar S, Shoukat R, Sikandar R. Postmenopausal uterine bleeding; correlation of the findings of transvaginal ultrasonography & endometrial sampling in patient. Professional Med J 2016; 23(12):1471–6.

Moradan SA, Ghorbani RB, Far MFC. Does transvaginal ultrasonography have good diagnostic value in endometrial pathology? Inter Medical J Malaysia 2011; 10(2):17–20

Sadoon S, Salman G, Smith G, Henson C, MacCollough W. Ultrasonographic endometrial thickness for diagnosing endometrial pathology in postmenopausal bleeding. J Obstet Gynecol 2007; 27(4):406–8.

Gull B, Karlsson B, Milsom I, Granberg S. Can ultrasound replace dilatation and curettage? A longitudinal evaluation of postmenopausal bleeding and transvaginalsonographic measurement of endometrial cancer. Am J Obstet Gynecol; 2003; 188:401–8.

Sedeq MS, Muhammed PR, ShekhMuhammed SS, Alalaf SK. A prospective comparison of transvaginal, transabdominal ultrasound and diagnostic curettage in the evaluation of endometrial pathology in Erbil. Zanco J Med Sci 2016; 20(1):1206–12.

Showkat MS, Nabi S, Khondker L, Bhowmik B, Tushar SN, Jahan MU. Role of transvaginalsonography in the detection of endometrial carcinoma. Bangladesh Med Res Counc Bull 2013; 39(2):80–5.

How to Cite
Sedeq, M., Dawood, S., Farooq, A., & Alalaf, S. (2019). Can vaginal ultrasound replace diagnostic curettage in the detection of endometrial pathology in post-menopausal bleeding?. Zanco Journal of Medical Sciences (Zanco J Med Sci), 23(2), 224-232.
Original Articles