Abnormal Uterine Bleeding: Comparison of Transabdominal and Transvaginal Sonography

Abstract

Introduction: Transabdominal (TAS) and transvaginal sonography (TVS) are the preferred modalities for initial imaging evaluation of abnormal uterine bleeding (AUB). The main causes of such bleeding in perimenopausal patients are endometrial polyp, adenomyosis, leiomyoma and endometrial hyperplasia. The aim of this study was to evaluate the findings and compare TAS and TVS in perimenopausal and menopausal patients with AUB.

Method: A prospective cohort study was performed and fifty nine perimenopausal and postmenopausal patients with AUB meeting the inclusion criteria were invited to participate in this study. TAS and TVS was done, findings recorded in proforma and analyzed.

Result: Mean endometrial thickness at various uterine levels was more on TVS compared to TAS. Abnormal findings like adenomyosis and nabothian cysts were detected on TVS than TAS. On TAS 41% of patients had bulky uterus while only 2.5 % had bulky uterus on TVS. Diagnosis of intramural fibroid on TVS and TAS was comparable; however, submucosal fibroids were better visualized on TVS.

Conclusion: TVS is better to diagnose endometrial polyps, submucosal fibroids, nabothian cysts and adenomyosis while TAS is superior in cases of bulky uterus. In cases with intramural fibroids and endometrial hyperplasia, both were comparable. TAS should still be used as the initial monitoring method for gynecologic abnormalities due to its greater depth penetration and thus wider field of view and should be followed by TVS.