The role of transvaginal ultrasound in the investigation of women with post-menopausal bleeding.

One-hundred and eighty-two women with post menopausal bleeding were examined with transvaginal ultrasound (TVUS) over a 16-month period. The imaging findings were correlated with the pathological specimens. One-hundred and forty had pipelle aspiration cytology and 35 hysteroscopy, dilatation and currettage and seven a hysterectomy. Endometrial thickness on TVUS was classified as either thin (equal to or less than 5 mm), thick (greater than 5 mm), or not seen. A thin endometrium was noted in 87 patients, in whom no pathological abnormality was found in 84 (negative predictive value 95%). There were three cases of hyperplasia or polyps but no carcinomas occurred in this group (negative predictive value for carcinoma 100%). A thickened endometrium was noted in 82 patients. In this group there were five carcinomas, nine polyps and eight cases of endometrial hyperplasia (positive predictive value 29%). In five patients the endometrium could not be identified. One carcinoma occurred in this group. There were an additional eight patients who were taking tamoxifen who were grouped separately. If a clear symmetrical endometrial stripe measuring less than or equal to 5 mm in thickness on TVUS is seen the probability of malignancy is extremely low and endometrial biopsy can probably be avoided in this group particularly in the context of an isolated episode of postmenopausal bleeding. If the endometrium is not seen or is thicker than 5 mm then endometrial biopsy is indicated.