May 2003 · Vol. 15, No. 5Assessment of abnormal uterine bleeding: 3 office-based tools
Sophisticated, user-friendly tools now available for office diagnosis of dysfunctional bleeding are underutilized. Here, a thorough assessment of transvaginal ultrasound, saline-infusion sonography, and hysteroscopy.
LINDA
D.
BRADLEY,
MDDr. Bradley is director of hysteroscopic services, Cleveland Clinic Foundation
Cleveland, Ohio.
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KEY POINTS
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Identification and measurement of the endometrial echo and descriptions of the echogenicity and heterogeneity of the endometrium are key to defining endometrial health.
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The introduction of intracervical fluid (saline-infusion sonography) during transvaginal ultrasound is one of the most significant advances in ultrasonography of the past decade.
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Hysteroscopic visualization has several advantages: immediate office evaluation, direct visualization of the endometrium and endocervix, and the ability to detect minute focal endometrial pathology and to perform directed endometrial biopsies.
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Sometimes a combination of procedures may be the best way to determine the cause of abnormal uterine bleeding.
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Because office-based physicians tend to feel comfortable relying upon endometrial biopsy or dilation and curettage (D&C) to evaluate abnormal uterine bleeding, newer tools—transvaginal ultrasound (TVUS), saline-infusion sonography (SIS), and hysteroscopy—see far too little utilization. Although these modalities are remarkably user-friendly when employed correctly, only 28% of gynecologists perform office hysteroscopy, and even fewer use SIS.1
This article reviews indications for use, sensitivity and specificity, advantages and disadvantages, special considerations including cost issues, and suggestions for incorporating these modalities into gynecologic practice.
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