Uterine Bleeding In Premenopausal Women Research Articles

PREMENOPAUSAL PERIOD AND ABNORMAL UTERINE BLEEDING

The article describes the analysis of abnormal uterine bleeding in premenopausal women, studies the causes and methods of treatment. The study was conducted in the gynecological department of the 1st clinic of the Samarkand State Medical University for 2021-2022. The study used general medical, clinical laboratory and instrumental diagnostic methods. The study investigated the causes and treatments for abnormal uterine bleeding and recommendations for improving treatment methods are given.

Evaluation of a Standardized Questionnaire for Initial Assessment of Abnormal Uterine Bleeding in Premenopausal Women

ObjectiveTo assess the effect of a standardized questionnaire for premenopausal women with abnormal uterine bleeding (AUB) on clinical information collection and duration of consultation. MethodsWe conducted a before and after study involving 100 premenopausal women undergoing consultation for AUB. During stage 1, 50 consultations were recorded on a consultation sheet with no specific template. During stage 2, 50 women completed a 26-item auto-administered standardized questionnaire before the consultation, which was then reviewed with the consultant and added to the medical record. The duration of consultation was assessed in subgroups of 27 women in each stage. Two independent evaluators assessed the quality and completeness of data collected in the medical records using a score sheet developed by experts. Outcomes from both stages were compared using the t test. ResultsThe descriptive characteristics were similar in both groups. The mean global scores of the quality and completeness of data collected improved significantly between stages 1 and 2, from 67% ± 12% to 95% ± 5% (P < 0.0001), as did medical background scores (54% ± 29% vs. 85% ± 13%; P < 0.0001) and AUB-related symptoms scores (69% ± 13% vs. 97% ± 5%; P < 0.0001). A mean reduction in duration of consultation of nearly 4 minutes was observed (24.6 ± 4.3 min vs. 20.7 ± 4.8 min; P < 0.0001). ConclusionThe AUB-specific standardized questionnaire improves quality and completeness of data collected in medical records and reduces duration of consultation.

Role of Antimicrobials in management of Dysfunctional Uterine Bleeding in Premenopausal Women

Role of Antimicrobials in management of Dysfunctional Uterine Bleeding in Premenopausal Women

354 The role of 3D ultrasonography and histopathology in diagnosis of abnormal uterine bleeding in premenopausal women

Introduction: Abnormal uterine bleeding in premenopausal women is one of the most common presenting complaints in gynecology clinics. It is a complicated clinical problem with different causes. However, physicians with a solid knowledge of menstrual physiology and a through approach to differential diagnosis can evaluate and manage the problem with confidence. Aim of work: The aim of this work is to evaluate the role of 3D ultrasonography and endometrial sampling, in comparison to each other, in detection of endometrial pathologies in premenopausal women having abnormal uterine bleeding.

A CASE STUDY ON THE TRAINING OF PELVIC FLOOR MUSCLE FOLLOWING HYSTERECTOMY TO IMPROVE THE QUALITY OF LIFE

Now a day’s abnormal uterine bleeding in premenopausal women is the most common indication of hysterectomy which usually results from myomas and adenomyosis. In this case study, a 38-year-old female, with a complaint of abnormally heavy bleeding with menstrual cycle irregularity and discomfort for 15 days each month with dysmenorrhoea. She was diagnosed for large fibroid deposition at the posterior wall of the uterus and extroverted in the position. So, she was prescribed for vaginal Hysterectomy by a gynecologist further investigation, she underwent a vaginal hysterectomy, post-operatively patient was complaining about lower abdominal pain and difficulty in bed mobility activities. There was weakness in pelvic floor muscles after the surgery, due to which she had worried about overweight, physical health, and her quality of life. So she approached the physiotherapist, where she had trained for pelvic floor muscle training two-three sessions per day for two weeks with abdominal, back, and hip strengthening exercises with a home exercise program. VAS scale, Oxford grading system, PFIQ, QOL questionnaire was taken as outcome measure prior and after the intervention. The present case report emphasizes the effect of the combination of different exercises for pelvic floor muscles encasing the comprehensive rehabilitation plan including a home exercise regimen allowing the patient to recover early and return to daily activities.

An Immunohistochemical Study of Estrogen and Progesterone Receptors in Endometrium of Women with Dysfunctional Uterine Bleeding

Abnormal Uterine Bleeding (AUB) is a common complaint that affects large numbers of women from puberty to menopause. It negatively affects health and quality of life of women affected. AUB also has an economic impact for both women and society Abnormal uterine bleeding in premenopausal women is one of the most frequent problems in gynecological practice. Although some of the cases may be due to an organic cause, over 50% of the patients undergoing hysterectomy for menorrhagia have dysfunctional uterine bleeding (DUB). To analyze the percentage and intensity of estrogen receptors (ER) and progesterone receptors (PR) in endometrium of patients with DUB. This study suggests that estrogen and progesterone receptors have an important role in etiopathogenesis of dysfunctional uterine bleeding and alteration in the morphology of endometrium such as development of endometrial hyperplasia. Women in the reproductive age who are complaining of abnormal uterine bleeding, usually have an increase in ER alpha and PR expression in their endometrium.

2020 Hong Kong College of Obstetricians and Gynaecologists guideline on investigations of premenopausal women with abnormal uterine bleeding.

Abnormal uterine bleeding in premenopausal women is a common gynaecological symptom and composes of abnormality in the frequency, duration, regularity, and flow volume of menstruation. It could constitute the presentation of various gynaecological malignancies. An appropriate history and physical examination are mandatory to ascertain the diagnosis. Depending on the clinical condition, a complete blood picture, thyroid function test, clotting profile, chlamydia test, cervical smear, and pregnancy test can be performed. Ultrasound should be performed in cases with a pelvic mass, unsatisfactory physical examination, persistent symptoms, or no response to medical treatment. In women aged ≥40 years, an out-patient endometrial biopsy with Pipelle should be performed. In women aged <40 years with risk factors for endometrial cancer, persistent symptoms, or no response to medical treatment, an endometrial biopsy should be performed to rule out endometrial cancer. Hysteroscopy or saline infusion sonohysterography is more sensitive than ultrasound for diagnosing endometrial pathology. Details of the above recommendations are presented.

A clinical study on abnormal uterine bleeding in premenopausal women

Background: Abnormal uterine bleeding is defined as any bleeding outside of normal menstrual cycle with excessive duration, frequency and amount of loss. AUB accounts about 70% in perimenopausal women in gynaecology OPD. Abnormal uterine bleeding is not a disease, it is a symptom. The aim of the study was to evaluate abnormal uterine bleeding in perimenopausal women and to study the various menstrual abnormalities and causes of AUB in perimenopausal women. Study design: This study was a hospital based cross sectional study which included 95 women in perimenopausal age group (40-51 years) with abnormal uterine bleeding. The history, clinical examination, USG and histopathological findings was collected. Clinical findings were classified by PALM-COEIN classification. All women underwent endometrial sampling to rule out endometrial pathology. Results: The mean age of the patients was 44.89(±2.93) years. Parity of more than 2 (46.3%) was most common. Menorrhagia (58.9%) was the most common bleeding pattern followed menometrorrhagia (23.2%). Leiomyomo 37 (38.9%) was the most common clinical finding followed by adenomyosis 29 (30.5%). Ultrasonographically fibroid uterus (37.8%) was the most common USG findings followed by Adenomyosis (30.5%). The most common endometrial thickness was 9-12mm (43.1%). Histopathological examination revealed secretory phase endometrium (35.8%) was the most common finding followed by proliferative endometrium (20%). Conclusion: Uterine fibroid was the leading cause of AUB. Clinical examination and ultrasound findings correlated well in the diagnosis of fibroids. Evaluation of the endometrium in perimenopausal women presenting with AUB is essential to rule out endometrial pathology.

Recurrence and prediction of abnormal uterine bleeding and re-intervention after initial hysteroscopic treatment: a retrospective cohort study.

To estimate the incidence of recurrence of complaints and repeated interventions after hysteroscopic treatment for abnormal uterine bleeding in premenopausal women and to determine potential predictors for re-intervention. This is a retrospective cohort study in two secondary care centers in the Netherlands. We included 313 premenopausal women who underwent hysteroscopy for complaints of abnormal uterine bleeding and who had intrauterine pathology visualized at ultrasound. The intrauterine structure was hysteroscopically removed. These women were compared with women who had a hysteroscopy for abnormal uterine bleeding, but in whom hysteroscopy showed no abnormalities. We used Chi-squared test for categorical variables and independent-samples T test for continuous variables. p Values less than 0.05 were considered to indicate statistical significance. In total, 262 women had intrauterine pathology removed at hysteroscopy; 136 (52%) women had recurrence of complaints, while 101 women (39%) underwent re-intervention. Heavy menstrual bleeding at baseline and multiparity were predictive factors for recurrence of abnormal uterine bleeding and re-intervention. In the 51 women with abnormal uterine bleeding in whom hysteroscopy showed no intrauterine abnormality, 29 women (60%) had recurrence of complaints and 12 (24%) a re-intervention. In premenopausal women with abnormal uterine bleeding, treatment of intrauterine pathology often does not reduce the complaints, thus questioning the effectiveness of hysteroscopic removal of these structures.

No. 292-Abnormal Uterine Bleeding in Pre-Menopausal Women.

Abnormal uterine bleeding is the direct cause of a significant health care burden for women, their families, and society as a whole. Up to 30% of women will seek medical assistance for this problem during their reproductive years. This guideline replaces previous clinical guidelines on the topic and is aimed to enable health care providers with the tools to provide the latest evidence-based care in the diagnosis and the medical and surgical management of this common problem. To provide current evidence-based guidelines for the diagnosis and management of abnormal uterine bleeding (AUB) among women of reproductive age. Outcomes evaluated include the impact of AUB on quality of life and the results of interventions including medical and surgical management of AUB. Members of the guideline committee were selected on the basis of individual expertise to represent a range of practical and academic experience in terms of location in Canada, type of practice, subspecialty expertise, and general gynaecology background. The committee reviewed relevant evidence in the English medical literature including published guidelines. Recommendations were established as consensus statements. The final document was reviewed and approved by the Executive and Council of the SOGC. This document provides a summary of up-to-date evidence regarding diagnosis, investigations, and medical and surgical management of AUB. The resulting recommendations may be adapted by individual health care workers when serving women with this condition. Abnormal uterine bleeding is a common and sometimes debilitating condition in women of reproductive age. Standardization of related terminology, a systematic approach to diagnosis and investigation, and a step-wise approach to intervention is necessary. Treatment commencing with medical therapeutic modalities followed by the least invasive surgical modalities achieving results satisfactory to the patient is the ultimate goal of all therapeutic interventions. Published literature was retrieved through searches of MEDLINE and the Cochrane Library in March 2011 using appropriate controlled vocabulary (e. g., uterine hemorrhage, menorrhagia) and key words (e. g., menorrhagia, heavy menstrual bleeding, abnormal uterine bleeding). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies written in English and published from January 1999 to March 2011. Searches were updated on a regular basis and incorporated in the guideline to February 2013. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology- related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table1). Implementation of the guideline recommendations will improve the health and well-being of women with abnormal uterine bleeding, their families, and society. The economic cost of implementing these guidelines in the Canadian health care system was not considered. RECOMMENDATIONS.

Endometrial Biopsy: American College of Nurse-Midwives.

Endometrial biopsy can be used to diagnose endometrial hyperplasia, endometrial cancer, and uterine infections. This cost-effective procedure has minimal side effects, and complications are rare. The purpose of this clinical bulletin is to provide clinicians with guidance about endometrial biopsy including the procedure's advantages and disadvantages, indications and contraindications, and side effects. In addition, step-by-step instructions for performing endometrial biopsy, the equipment required, selection of sampling devices, and care before and after the procedure are discussed.

Abnormal Uterine Bleeding: American College of Nurse-Midwives.

Variations in uterine bleeding, termed abnormal uterine bleeding, occur commonly among women and often are physiologic in nature with no significant consequences. However, abnormal uterine bleeding can cause significant distress to women or may signify an underlying pathologic condition. Most women experience variations in menstrual and perimenstrual bleeding in their lifetimes; therefore, the ability of the midwife to differentiate between normal and abnormal bleeding is a key diagnostic skill. A comprehensive history and use of the PALM-COEIN classification system will provide clear guidelines for clinical management, evidence-based treatment, and an individualized plan of care. The purpose of this Clinical Bulletin is to define and describe classifications of abnormal uterine bleeding, review updated terminology, and identify methods of assessment and treatment using a woman-centered approach.

Endometrial thickness by USG as a guideline for the treatment of Dysfunctional uterine bleeding in Premenopausal Women

Introduction: Endometrium is mucosal layer of uterus. Throughout the reproductive age, endometrium undergoes cyclical changes during each lunar month to prepare uterus for implantation. Dysfunctional uterine bleeding (DUB) is the most common cause of abnormal vaginal bleeding (AUB) during a womans reproductive years. It affects womens health both medically and socially. Aim & Objective: To decide cut of limit of Endometrial thickness (ET) by ultrasonography (USG) for the treatment of DUB patients in premenopausal women. Method: A total of 60 patients with irregular menstrual bleeding of DUB attending Department of Obstetric and Gynecology in M G M Medical College and Hospital were selected. ET was noted by USG. Result: In younger age group most of patients showed good response to medical line of treatment, while premenopausal women needed surgical line of treatment. Conclusion: ET in younger age group is in the normal range ( 8 mm.

Abnormal Uterine Bleeding in Pre-Menopausal Women

BackgroundAbnormal uterine bleeding is the direct cause of a significant health care burden for women, their families, and society as a whole. Up to 30% of women will seek medical assistance for this problem during their reproductive years. This guideline replaces previous clinical guidelines on the topic and is aimed to enable health care providers with the tools to provide the latest evidence-based care in the diagnosis and the medical and surgical management of this common problem. ObjectiveTo provide current evidence-based guidelines for the diagnosis and management of abnormal uterine bleeding (AUB) among women of reproductive age. OutcomesOutcomes evaluated include the impact of AUB on quality of life and the results of interventions including medical and surgical management of AUB. MethodsMembers of the guideline committee were selected on the basis of individual expertise to represent a range of practical and academic experience in terms of location in Canada, type of practice, subspecialty expertise, and general gynaecology background. The committee reviewed relevant evidence in the English medical literature including published guidelines. Recommendations were established as consensus statements. The final document was reviewed and approved by the Executive and Council of the SOGC. ResultsThis document provides a summary of up-to-date evidence regarding diagnosis, investigations, and medical and surgical management of AUB. The resulting recommendations may be adapted by individual health care workers when serving women with this condition. ConclusionsAbnormal uterine bleeding is a common and sometimes debilitating condition in women of reproductive age. Standardization of related terminology, a systematic approach to diagnosis and investigation, and a step-wise approach to intervention is necessary. Treatment commencing with medical therapeutic modalities followed by the least invasive surgical modalities achieving results satisfactory to the patient is the ultimate goal of all therapeutic interventions. EvidencePublished literature was retrieved through searches of MEDLINE and the Cochrane Library in March 2011 using appropriate controlled vocabulary (e.g. uterine hemorrhage, menorrhagia) and key words (e.g. menorrhagia, heavy menstrual bleeding, abnormal uterine bleeding). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies written in English and published from January 1999 to March 2011. Searches were updated on a regular basis and incorporated in the guideline to February 2013.Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. ValuesThe quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table). Benefits, harms, and costsImplementation of the guideline recommendations will improve the health and well-being of women with abnormal uterine bleeding, their families, and society. The economic cost of implementing these guidelines in the Canadian health care system was not considered.

Abnormal Uterine Bleeding in Pre-Menopausal Women

BackgroundAbnormal uterine bleeding is the direct cause of a significant health care burden for women, their families, and society as a whole. Up to 30% of women will seek medical assistance for this problem during their reproductive years. This guideline replaces previous clinical guidelines on the topic and is aimed to enable health care providers with the tools to provide the latest evidence-based care in the diagnosis and the medical and surgical management of this common problem. ObjectiveTo provide current evidence-based guidelines for the diagnosis and management of abnormal uterine bleeding (AUB) among women of reproductive age. OutcomesOutcomes evaluated include the impact of AUB on quality of life and the results of interventions including medical and surgical management of AUB. MethodsMembers of the guideline committee were selected on the basis of individual expertise to represent a range of practical and academic experience in terms of location in Canada, type of practice, subspecialty expertise, and general gynaecology background. The committee reviewed relevant evidence in the English medical literature including published guidelines. Recommendations were established as consensus statements. The final document was reviewed and approved by the Executive and Council of the SOGC. ResultsThis document provides a summary of up-to-date evidence regarding diagnosis, investigations, and medical and surgical management of AUB. The resulting recommendations may be adapted by individual health care workers when serving women with this condition. ConclusionsAbnormal uterine bleeding is a common and sometimes debilitating condition in women of reproductive age. Standardization of related terminology, a systematic approach to diagnosis and investigation, and a step-wise approach to intervention is necessary. Treatment commencing with medical therapeutic modalities followed by the least invasive surgical modalities achieving results satisfactory to the patient is the ultimate goal of all therapeutic interventions. EvidencePublished literature was retrieved through searches of MEDLINE and the Cochrane Library in March 2011 using appropriate controlled vocabulary (e.g. uterine hemorrhage, menorrhagia) and key words (e.g. menorrhagia, heavy menstrual bleeding, abnormal uterine bleeding). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies written in English and published from January 1999 to March 2011. Searches were updated on a regular basis and incorporated in the guideline to February 2013.Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. ValuesThe quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). Benefits, harms, and costsImplementation of the guideline recommendations will improve the health and well-being of women with abnormal uterine bleeding, their families, and society. The economic cost of implementing these guidelines in the Canadian health care system was not considered.

Dysfunctional uterine bleeding: from adolescence to menopause.

Dysfunctional uterine bleeding (DUB) is defined as excessive or prolonged uterine bleeding in premenopausal women that is not caused by pelvic pathology, medications, systemic disease or pregnancy. It is a common condition that can lead not only to physical symptoms such as iron deficiency, anaemia, cramps and fatigue, but also has significant psychological and social effects that impair a woman's quality of life. Progesterone is highly important in the regulation of menstrual bleeding and a progesterone-deficient anovulatory state is a common cause of DUB. There are a wide range of treatment options available including hormonal therapies (oral cyclical progestogens, depot progestogens, progestogen-releasing intrauterine devices, combined oral contraceptives, danazol, gonadotrophin-releasing hormone analogues and hormone replacement therapy), non-hormonal therapies (non-steroidal anti-inflammatory drugs and antifibrinolytic drugs) and surgery (hysterectomy and endometrial ablation). The choice of appropriate therapy should be based on factors such as the mechanism behind the DUB, which symptoms are most problematic, and the woman's need for fertility or contraception. However, there is currently a lack of clinical evidence to help support these decisions.

Acute Leukemia in Women

The treatment and survival outcome of acute leukemia in women is generally similar to that of men. However, acute leukemia in women poses additional challenges in clinical practice. In addition to important precautions during therapy, such as prevention of abnormal uterine bleeding in premenopausal women and therapy during pregnancy, women who are survivors of acute leukemia face unique and potentially long-term health-related problems. In this review, we address the aforementioned issues, as well as the various health and psychosocial challenges faced by women who survive childhood leukemia during their path to adulthood. Finally, we address the issue of therapy-related acute leukemia in the category of women who are survivors of breast and ovarian cancer.

Decreased expression of endometrial vessel AQP1 and endometrial epithelium AQP2 related to anovulatory uterine bleeding in premenopausal women

Aquaporins (AQPs) may be involved in the occurrence of abnormal uterine bleeding as the mediators between ovarian steroids and cyclic endometrial changes. The aim of the present study was to investigate the characteristics of endometrial AQPs in women with anovulatory uterine bleeding and explore the relationship between endometrial AQPs and ovarian steroids. Sixty-one women with premenopausal anovulatory uterine bleeding and 108 women with normal cycles were involved in this study. Endometrial biopsies were obtained from the women with anovulatory uterine bleeding and normal control women. Serum estradiol and progesterone concentrations were measured with enzyme-linked immunosorbent assay on the same day as an endometrial biopsy was performed. AQP1 and AQP2 mRNA expression was evaluated using reverse-transcriptase polymerase chain reaction. Immunohistochemistry was used to localize AQP1 and AQP2 in the endometrium, and their expression was quantified by an image analysis/measuring system. AQP1 was located in the endothelium of small vessels, whereas AQP2 was mainly found in luminal and glandular epithelium. The expression levels of AQP1 and AQP2 mRNA and protein were higher in the secretory phase than those in the proliferative phase (P < 0.01) in normal endometrium, and their expression was related to serum steroid hormones (P < 0.01). However, the expression of AQP1 and AQP2 decreased in the endometrium in anovulatory uterine bleeding comparing with normal endometrium (P < 0.01). The correlation between AQP expression and ovarian steroids vanished (P > 0.05) in anovulatory uterine bleeding. Our findings indicate that cyclic expression of endometrial AQP1/AQP2 correlated with steroid hormone levels may be essential to normal endometrial function and decreased AQP1/AQP2 expression in endometrial vessels or epithelium may be involved in the occurrence of anovulatory uterine bleeding.

Detection of benign endometrial masses by endometrial stripe measurement in premenopausal women.

Our objective was to estimate whether a transvaginal endometrial stripe of less than 5 mm in premenopausal women would exclude endometrial polyps and intracavitary leiomyomata, thereby eliminating the need for sonohysterography. Data from 206 consecutive sonohysterograms performed in premenopausal women with abnormal uterine bleeding between August 1998 and October 2001 were collected retrospectively. Endometrial stripe measurements were obtained in the sagittal plane before sonohysterography. Baseline endometrial stripe images were reviewed by one of the authors, who was blinded to sonohysterography and pathology results, to evaluate for gross endometrial abnormalities on transvaginal ultrasonography. Endometrial stripe measurements were obtained before sonohysterography in 200 of the 206 consecutive exams in premenopausal subjects. Of the 80 subjects with an endometrial stripe measurement less than 5 mm, 11 had endometrial polyps and 5 had submucosal fibroids on sonohysterography. With an endometrial stripe thickness of less than 5 mm, the sensitivity was 74% (95% confidence interval 62-84), the specificity was 46% (95% confidence interval 38-54), the positive predictive value was 37%, and the negative predictive value was 80%. The detection of pathology was not improved by excluding cases with an abnormal-appearing endometrial stripe on the baseline transvaginal images. The use of other endometrial stripe cutoff values did not improve the diagnostic accuracy. Using an endometrial stripe cutoff of 5 mm in premenopausal women would miss significant intracavitary pathology. The sonographic evaluation of abnormal uterine bleeding in premenopausal women should include sonohysterography or equivalently accurate testing regardless of endometrial stripe thickness.

A systematic review of transvaginal ultrasonography, sonohysterography and hysteroscopy for the investigation of abnormal uterine bleeding in premenopausal women.

To determine the accuracy of transvaginal ultrasonography, sonohysterography and diagnostic hysteroscopy for the investigation of abnormal uterine bleeding in premenopausal women. Systematic review of common diagnostic imaging tests. Relevant papers were identified through electronic searching of MEDLINE (1980 to July 2001) and EMBASE (1980 to July 2001) and manual searching of a bibliography of primary and review articles. Studies were selected if accuracy of transvaginal ultrasonography, sonohysterography and diagnostic hysteroscopy was compared with a reference standard and included data that could be abstracted into a two-by-two table in order to calculate sensitivity and specificity. Quality assessment and data extraction were performed by at least two independent reviewers. Diagnostic accuracy was determined by calculating positive and negative likelihood ratios for all intrauterine pathologies, submucous fibroids and endometrial hyperplasia. Nineteen studies met the inclusion criteria. Statistically significant heterogeneity was present between the likelihood ratios for studies of transvaginal ultrasound. A positive test result with sonohysterography diagnosed submucous fibroids with a pooled likelihood ratio of 29.7 (17.8, 49.6). A positive test result with hysteroscopy diagnosed submucous fibroids with a pooled likelihood ratio of 29.4 (13.4, 65.3), and any intrauterine pathology with a pooled likelihood ratio of 7.7 (4.3, 13.7). A negative test result with hysteroscopy for diagnosing any intrauterine pathology had a pooled likelihood ratio of 0.07 (0.04, 0.15). Although there was considerable variability present between the studies, all three diagnostic tests were moderately accurate in detecting intrauterine pathology. However, sonohysterography and hysteroscopy performed better than transvaginal ultrasound in detecting submucous fibroids.