POSTMENOPAUSAL BLEEDING: THE VALUE OF TRANS-VAGINAL SONOGRAPHY VERSUS SALINE INFUSION SONO-HYSTEROGRAPHY IN IDENTIFYING THE UTERINE CAUSES FOR BLEEDING.

Background:- Postmenopausal bleeding (PMB) is relatively common problem and a cause for concern due to increased incidence of endometrial carcinoma in this age group Objective:- To evaluate the diagnostic accuracy of transvaginal sonography (TVS) and saline infusion sonohysterography (SISH) in the assessment of endometrium state in patients with PMB Methods:- prospective study included 37 patients with PMB . All the patients underwent TVS & SISH , the endometrium was assessed for maximum thickness , regularity , echogeneity , homogeneity , the presence of mass.The final diagnoses was obtained from histopathology . Results:- according to the histopathology 16 patients(34.24)% had normal endometrium , 6 patients(16.22)% had benign endometrial polyp,12 patients(32.43)% had endometrial hyperplasia ,2 patients (5.41)% had submucosal fibroid and 1of the patients (2.70)% had endometrial carcinoma . Both TVS and SISH were 100% accurate in making the diagnosis of endometrial Polyp, sub mucosal fibroid and endometrial carcinoma however, TVS overestimated 4 cases of normal endometrium as endometrial hyperplasia giving an accuracy of 89.19% , on the other hand SISH accurately defined all the cases of endometrial hyperplasia Conclusion:- Both TVS and SISH have comparable accuracy in the assessment of endometrial pathology in women with PMB , however TVS may overestimate endometrial hyperplasia