Use of sonohysterography in the diagnosis and management of abnormal uterine bleeding

Abstract

Objective: To assess the effectiveness of saline contrast sonohysterography in the diagnosis and management of abnormal uterine bleeding.Materials and methods: Fifty‐two patients (aged 28–56 years) with abnormal uterine bleeding were included in a prospective study. They underwent a transvaginal ultrasonography as well as saline contrast sonohysterography. Patients with findings of uterine cavity abnormalities (endometrial polyps or submucous myomas) were advised surgery (operative hysteroscopy or hysterectomy). Patients with normal cavity or thickened endometrium underwent diagnostic hysteroscopy and biopsy, following which they were advised medical therapy or thermal ablation of the endometrium.Results: Saline contrast sonohystergraphy depicted endometrial polyps (n = 22), submucous fibroids (n = 18) and normal cavities (n = 12). Hysteroscopic surgery resolved the bleeding in 20 of the patients with polyps and in 12 of the patients with fibroids. The findings of the measurement and localization of the lesions on saline contrast sonohysterography displayed good reliability at the time of surgery. Of the 12 patients with normal uterine cavity, eight patients had a normal histopathological report on biopsy and were offered either medical therapy or endometrial thermal ablation. Three patients had endometrial hyperplasia without atypia and one patient had endometrial carcinoma and underwent definitive surgery. The procedure of saline contrast sonohysterography was well tolerated by all patients with very minimal side‐effects. Between transvaginal ultrasound and saline contrast sonohysterography, the latter was found to be more specific and sensitive and the likelihood ratio was improved significantly with the use of this modality.Conclusions: Saline contrast sonohysterography enhances endovaginal ultrasound examination of the uterine cavity in patients with abnormal uterine bleeding. It is easy and safe to perform, and its use can optimize the therapeutic interventions.