Evaluation Of Uterine Cavity Research Articles

OC10.01: Comparative study of two‐ and three‐dimensional sonohysterography versus office hysteroscopy for the evaluation of uterine cavity in the reproductive age

<scp>OC</scp>10.01: Comparative study of two‐ and three‐dimensional sonohysterography versus office hysteroscopy for the evaluation of uterine cavity in the reproductive age

The Value of Diagnostic Hysteroscopy before Operative Hysteroscopy for Suspected Abnormal Intrauterine Findings

Study ObjectiveTo evaluate the accuracy of diagnostic office hysteroscopy in the detection of abnormal uterine findings in symptomatic and asymptomatic patients and compare it with the accuracy of operative hysteroscopy. DesignA retrospective analysis of all women after operative hysteroscopy between 2010 and 2012 in our institution (Canadian Task Force classification II-2). SettingThe department of gynecology in a tertiary referral medical center. PatientsOne hundred thirty-two patients with a mean age of 48 years after diagnostic office hysteroscopy and subsequent operative hysteroscopy. InterventionsOperative hysteroscopy. Measurements and Main ResultsWe collected demographic and clinical data from patients' charts. The indications as well as findings of the previous diagnostic modality (transvaginal ultrasound [TVUS] and diagnostic hysteroscopy) were gathered and compared with the final tissue diagnosis obtained via operative hysteroscopy. Positive predictive values in diagnostic hysteroscopy were calculated for common pathological intrauterine findings. Forty-eight patients (37%) were menopausal, and 84 (63%) were premenopausal. The indications for hysteroscopy were abnormal uterine bleeding in 46% of patients and suspected uterine finding in 44%. A TVUS preceded the diagnostic hysteroscopy in 105 women (80%). Older female age, menopausal status, and abnormal intrauterine findings larger than 15 mm were associated with significantly greater true-positive rates on diagnostic hysteroscopy (i.e., the suspected findings on diagnostic hysteroscopy were verified by final pathology). Uterine bleeding during the interval between procedures was marginally significant and associated with greater false-positive results. Bleeding as opposed to routine evaluation of uterine cavity, interval between procedures, location of intrauterine finding, and hormone replacement therapy were not associated with greater true-positive values. ConclusionAlthough diagnostic hysteroscopy is superior to TVUS in the assessment of polyps, it contributes little to TVUS when myomas and endometrial hyperplasia are suspected. Therefore, it should not be used routinely as an interface between TVUS and operative hysteroscopy when such findings such are suspected. Furthermore, in premenopausal patients with abnormal uterine bleeding between diagnostic and operative procedures and when small (<15 mm) polyps are suspected, it might be worthwhile to repeat a diagnostic procedure before operative hysteroscopy.

Hysteroscopic findings in infertile women: A retrospective study

Abstract Background Lower pregnancy rates are observed in patients with uterine cavity anomalies. The correction of these anomalies has been associated with improved pregnancy rates. Diagnostic hysteroscopy can be performed in an office with minimal discomfort and superior sensitivity and specificity in evaluation of the uterine cavity. Our study was done to evaluate the importance of office hysteroscopy (OH) in diagnosis of pathology among infertile women. Objective To study incidence of abnormal hysteroscopic findings among infertile women. Materials and Methods We retrospectively studied 432 office hysteroscopies in patients referred to our unit because of their infertility problem. Two hundred and seventy-four patients (63.43%) were with primary infertility and 158 (36.57%) were with secondary infertility. Results Normal hysteroscopic findings were reported in 344 women (79.63%). The other 88 (20.37%) were with abnormal hysteroscopy. The most common reported hysteroscopic abnormality was intrauterine adhesions (IUA) 31.81% (28/88) followed by endometrial polyp 26.13% (23/88). Pre-hysteroscopic uterine investigations (ultrasound or hysterography) were available, only, in 207 women. In 143 patients with normal pre-hysteroscopic uterine investigations, office hysteroscopy revealed uterine cavity abnormalities in 21 women (14.68%). Of those with abnormal pre-hysteroscopic findings, 64 patients, hysteroscopy examinations were normal in 16 patients (25%). Conclusions Office hysteroscopy should be a part of routine work up in infertile patients as routine uterine investigatory methods (ultrasonography and hysterography) have only sensitivity and specificity value of 67.19% and 85.31% respectively.

Sonohysterosalpingography: a suitable choice in infertility workup.

To evaluate the efficacy, compliance, and cost effectiveness of sonohysterosalpingography (HyCoSy) compared with hysteroscopy for uterine cavity evaluation and compared with RX-hysterosalpingography (RX-HSG) for tubal patency determination. Three hundred and eight infertile patients underwent HyCoSy, hysteroscopy, and RX-HSG. We compared sensitivity, specificity, positive and negative predictive values (PPV and NPV), discomfort level, and cost of all three procedures. Sensitivity, specificity, PPV, and NPV were higher for HyCoSy than for hysteroscopy but the differences were not significant. HyCoSy also has the same accuracy as RX-HSG. Pain perception and cost were higher for RX-HSG and hysteroscopy than for HyCoSy. HyCoSy can be regarded as a procedure for initial evaluation of the uterine cavity and of tubal patency in infertile patients.

Should Diagnostic Hysteroscopy be Performed Before In Vitro Fertilization-Embryo Transfer?

The role of routine uterine cavity evaluation before an in vitro fertilization–embryo transfer (IVF-ET) cycle has not been uniformly accepted. Published trials have demonstrated a relatively high incidence of cavitary abnormalities diagnosed at outpatient hysteroscopy in patients with previous IVF-ET cycle failure, the correction of which markedly improves outcomes. The value of performing this procedure before an initial cycle in patients without previous implantation failure has not been definitively confirmed in prospective randomized trials, but would seem logical in an effort to minimize the number of cycles a patient must undergo. The incidence of cavitary abnormalities in this population varies. One large series has reported a 22.9% incidence of endometrial cavitary abnormalities diagnosed at pre-cycle office hysteroscopy in this patient group. Hysterosalpingography and baseline transvaginal ultrasonography are insufficiently sensitive alternatives. Sonohysterography with infusion of saline solution, in particular with 3-dimensional technology, may be a reasonable alternative to diagnostic hysteroscopy, although relatively few well-designed trials have addressed this issue. There are an insufficient number of prospective randomized trials to clearly demonstrate that surgical removal of all abnormalities improves IVF-ET outcome. However, investigators suggest a benefit for resection of submucosal leiomyomas, adhesions, and at least a subset of polyps. Appropriately designed trials are required before a definitive recommendation can be made.

Compressive Suture of the Lower Uterine Segment for the Treatment of Postpartum Hemorrhage due to Complete Placenta Previa: A Preliminary Study

Aim: To assess the efficacy of a uterine compression suture technique in controlling hemorrhage after removal of complete placenta previa during cesarean section. Methods: This prospective study was performed in a tertiary referral hospital and included 18 patients with postpartum hemorrhage following removal of complete placenta previa during elective cesarean section. All 18 patients underwent bilateral anteroposterior compression suture of the lower uterine segment. All patients were followed postpartum for evaluation of uterine cavity and menstrual cycles. Results: Anteroposterior compressive suture of the lower uterine segment achieved immediate complete hemostasis in all 18 patients. No surgical complication was observed. All patients recovered normal menstrual cycles. Normal patency of the uterine cavity was documented with sonohysterography in all patients at the 6-month follow-up visit. Conclusions: This quick and simple suture technique seems to be effective in stopping hemorrhage following complete placenta previa removal during cesarean section. Normal patency of the uterine cavity seems not to be impaired at medium-term follow-up.

Saline infusion sonohysterography versus hysteroscopy for uterine cavity evaluation

BACKGROUND AND OBJECTIVES:The most frequent procedures performed on women with abnormal uterine bleeding are 2D and 3D ultrasound. The most common accepted approach for the management of abnormal uterine bleeding is 2D TV scan followed by therapeutic hysteroscopy. The purpose of this prospective study was to assess whether 3D saline infusion sonohysterography (3D SIS) could replace diagnostic hysteroscopy (DH) for the diagnosis of endometrial pathology, in patients with abnormal uterine bleeding.DESIGN AND SETTING:A prospective study in the ultrasound department of the Women's Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia from January 2008 to February 2010.PATIENTS AND METHODS:0One hundred and one patients with abnormal uterine bleeding, suspected to have endometrial abnormality by 2D and 3D transvaginal scan, were prospectively studied. Of these, 55 patients had undergone both 3D SIS and DH, followed by verification of results with histopathology.RESULTS:Upon comparison of 3D SIS and DH individually with histopathology, specificity and sensitivity for 3D SIS were 67% and 100%, respectively, and for hysteroscopy 67% and 98%, respectively. In addition, the positive predictive value and negative predictive value were 98% and 100%, respectively, for 3D SIS, while for DH they were 98% and 67%, respectively.CONCLUSION:3D SIS is a safe alternative to hysteroscopy. However, larger randomized controlled trials should be conducted to ascertain the validity and reliability of this advantageous, less-invasive procedure, for women with abnormal uterine bleeding, who require evaluation of the endometrial cavity.

Uterine compression sutures for postpartum hemorrhage: is routine postoperative cavity evaluation needed?

Postpartum hemorrhage due to uterine atony continues to be one of the major causes of maternal morbidity and mortality. Several uterine compression suture techniques have been described and are increasingly being used worldwide as a conservative approach. However, little is known about the long-term effects on the uterine cavity, as well as fertility and pregnancy outcomes. We reviewed the reported complications and uterine findings after the use of compression sutures, both in examinations to evaluate the cavity (hysteroscopy, hysterosalpingography or sonohysterography) and at cesarean section, in order to assess the possible usefulness of routine postoperative cavity evaluation. Overall, the use of uterine compression sutures is effective and safe; however, some severe and potentially life-threatening complications have been reported and could possibly have been prevented if uterine cavity evaluation had been performed. Routine follow-up, both by hysteroscopy and an imaging technique, seems worthwhile.

Prevalence of Endometrial Polyp in Reproductive-Age Infertile Women

BACKGROUND: Endometrial polyps are focal overgrowths of glandular endometrium associated with reduced fecundity and increased rates of miscarriages. Previous studies on premenopausal women have noted a prevalence of polyps ranging widely from 3-24%. Little is known about the true prevalence of polyps in the general infertility patient population and whether uterine cavity evaluation is warranted in all infertility patients or only in certain subsets, based on clinical or demographic characteristics.

Acceptability and accuracy of saline infusion sonohysterography in women with postmenopausal bleeding.

To validate the diagnostic efficacy of saline infusion sonohysterography (SIS) in the evaluation of uterine cavity,in women with postmenopausal bleeding and endometrial thickness (3) 5 mm. Cross-sectional study. Military Hospital, Rawalpindi, from March 2005 to July 2008 and Combined Military Hospital, Multan, from September 2008 to June 2009. Seventy seven eligible participants included women complaining of postmenopausal bleeding were included; out of whom 69 completed the procedure satisfactorily. Pain scores during procedure were assessed to determine patient acceptability. Following saline infusion sonohysterography all patients also underwent an out door pipelle endometrial biopsy in a one-stop postmenopausal bleed clinic. Findings of sonohysterography were compared with hysteroscopy/hysterectomy specimen. Majority of the patients 34 (49.2%) experienced no pain during the procedure, 51 (74%) women had a positive SIS and the findings were negative in 18 (26%) patients. The commonest abnormal finding on SIS was focal thickening in 23 (32%) and endometrial polyp in 12 (17%) cases. Saline infusion hysterosonography picked up 3 cases of false positive polyps (5.8%) and missed a case of submucous fibroid near cervix (1.8%). Upon comparison of findings of hysteroscopy and hysterectomy in 53 cases, there was complete agreement in a total of 43 (88%) cases. The sensitivity of sonohysterography was 92% and specificity was 78%. All the ladies with abnormal SIS had diagnostic or therapeutic procedures and finally only 24 (35%) were managed on conservative follow-up. Normal SIS led to conservative management in 16 (88%). Sonohysterography in combination with endometrial biopsy is a useful technique useful for the evaluation of postmenopausal bleeding. Patient acceptability and diagnostic capability is high and it reduces demand for hysteroscopy.

Comparative Evaluation of Saline Infusion Sonohysterography and Hysterolaparoscopy for Diagnosis of Uterine Cavity Abnormalities and Tubal Patency in Infertility: A One Year Cross- sectional Study

ABSTRACT Objective To compare the diagnostic efficacy of saline infusion sonohysterography (SIS) with hysterolaparoscopy in evaluation of uterine cavity and tubal patency. Methods This prospective one year cross-sectional study was conducted at the assisted reproduction center (ARC), KLES Dr Prabhakar Kore Hospital and Medical Research Centre, Belgaum. A total of 60 patients underwent SIS for evaluation of uterine cavity and tubal patency. Subsequently all patients underwent hysterolaparoscopy with chromopertubation (CPT). Results of SIS and hysterolaparoscopy with chromopertubation were compared. Results For evaluation of uterine cavity, when compared with hysteroscopy, SIS had a sensitivity of 97.8%, specificity of 88.8%, positive predictive value (PPV) of 97.8% and negative predictive value (NPV) of 88.8%. For evaluation of tubal patency when SIS was compared to laparoscopy with CPT, SIS had a sensitivity of 83.3%, specificity of 82.9%, PPV of 42.9% and NPV of 97.5%. Conclusion Saline infusion sonohysterography is a noninvasive, simple, easy and cost-effective procedure. SIS is more sensitive and specific for evaluation of uterine cavity as compared to evaluation of tubal patency.

Prospective study of saline infusion sonography and office hysteroscopy

Background: To evaluate the diagnostic potential of saline infusion sonography to pick up uterine cavity lesions and compare it with the gold standard office hysteroscopy. Methods: Study population consisted of women scheduled for office hysteroscopy for various indications. Uterine cavity of 208 women of the study group were evaluated first by saline infusion sonography and then by office hysteroscopy by two separate examiners. Findings were recorded separately for both procedures and compared. Pain rating was also noted after each procedure. Result: In eight patients either or both the procedures could not be performed for various reasons, hence were excluded from the analysis. With saline infusion sonography, pathological findings were identified in 93 (46.5%) patients and hysteroscopy detected lesions in 88 (44%) patients. For all findings combined sensitivity of saline infusion sonography was 90.9%, specificity 88.3%, positive predictive value 86.0% and negative predictive value 92.5% as compared to hysteroscopy. Former was less painful and easier to perform than the latter. Conclusion: The findings of saline infusion sonography and office hysteroscopy did not differ significantly. Thus saline infusion sonography is an excellent option for uterine cavity evaluation.

Should endometrial polyps be removed in patients with postmenopausal bleeding?—an assessment of study designs and report of a failed randomised controlled trial (ISRCTN73825127)

We describe the design of a randomised controlled trial to evaluate the efficacy of endometrial polyp removal in women with postmenopausal bleeding. We designed a trial in which patients with postmenopausal bleeding and endometrial thickness >4 mm undergo hysteroscopy. If during hysteroscopy an endometrial polyp was diagnosed, patients were asked to participate in this trial and after informed consent allocated to immediate removal of the polyp or expectant management. This trial suffered from lack of recruitment related both to doctors seeking for informed consent as well as to patients' unwillingness to participate in this trial. However, a randomised controlled trial on this subject is still necessary to evaluate the efficacy of uterine cavity evaluation in the diagnostic work-up of women with postmenopausal bleeding, focussing on benign pathology. Therefore, we propose an alternative design, which might be more feasible.

Etiology of recurrent pregnancy loss in women over the age of 35 years

To determine the rate of embryonic chromosomal abnormalities, thrombophilias, and uterine anomalies in women over the age of 35 years with recurrent pregnancy loss (RPL). Retrospective cohort study. Academic reproductive endocrinology and infertility clinic. Women>or=35 years old with >or=3 first trimester miscarriages. None. Age, number of prior losses, cytogenetic testing of the products of conception (POC), uterine cavity evaluation, parental karyotype, TSH, and antiphospholipd antibody (APA) and thrombophilia testing. Aneuploidy in the POC in women with RPL was compared with sporadic miscarriages (<or=2 losses) in women>or=35 years. Among 43 RPL patients, there were 50 miscarriages in which cytogenetic analysis was performed. In the RPL group, the incidence of chromosomal abnormalities in the POC was 78% (39 out of 50) compared with a 70% incidence (98 out of 140) in the sporadic losses. Thrombophilia results in the RPL patients were normal in 38 patients, four patients had APA syndrome, and one had protein C deficiency. Forty out of 43 had normal uterine cavities. Both TSH and parental karyotypes were normal in all of the patients tested. When the evaluation of RPL included karyotype of the POC, only 18% remained without explanation. However, without fetal cytogenetics, 80% of miscarriages would have been unexplained. In older patients with RPL, fetal chromosomal abnormalities are responsible for the majority of miscarriages. Other causes were present in only 20% of cases.

Effect of diagnostic hysteroscopy with or without mechanical disruption of the endometrium in the infertile population

OBJECTIVE: Uterine cavity evaluation is routinely performed prior to IVF. Pregnancy rates at our center have improved among those patients undergoing hysteroscopy immediately prior to IVF stimulation compared to patients receiving evaluation remote from treatment (Mooney and Milki 2005). It is unknown if this benefit is secondary to mechanical stimulation of the endometrium or fluid distention and flushing of the endometrial cavity. The objective of this analysis is to examine the effects of mechanical stimulation of the endometrium at the time of hysteroscopy.

Comparison of transvaginal sonography, saline infusion sonography and hysteroscopy in the evaluation of uterine cavity pathologies

To determine whether performing transvaginal sonography (TVS) and saline infusion sonography (SIS) before hysteroscopy could reduce the number of diagnostic hysteroscopies performed for the evaluation of uterine cavity abnormalities. Two hundred and twenty three women with suspected uterine cavity abnormalities were prospectively evaluated by TVS, SIS and hysteroscopy, and had histological evaluation of the endometrium with hysteroscopic biopsy or dilatation and curettage (D&C). One hundred and sixty five patients (74%) were premenopausal and 58 patients (26%) were postmenopausal. The positive predictive value (PPV) for endometrial polyps was 69% for TVS, 78% for SIS and 81% for hysteroscopy in premenopausal patients. In the postmenopausal group, TVS and SIS could detect only 24% of endometrial polyps, whereas 70% were diagnosed by hysteroscopy. The PPV for submucous fibroids was 47% for TVS, 81% for SIS and 77% for hysteroscopy in the premenopausal group. In premenopausal patients, SIS and hysteroscopy are equally accurate in the diagnosis of endometrial polyps and submucous fibroids. Hysteroscopy is the most accurate test for polypoid lesions in the postmenopausal group. Performing TVS, SIS and D&C could reduce the number of diagnostic hysteroscopies performed for the evaluation of uterine cavity abnormalities by 71.5% in premenopausal patients. However, this rate decreases to 40% in the postmenopausal group.

Priming Effect of Misoprostol on Estrogen Pretreated Cervix in Postmenopausal Women

Misoprostol, which is a prostaglandin E1 analogue, is effectively used in cervical priming in women both for labor induction and for gynecological procedures. Although its efficacy is well documented in reproductive age women, during postmenopausal period this efficacy is limited probably due to estrogen deficit. Our objective is to evaluate if estrogen deficit in postmenopausal women is important for the effect of misoprostol on cervical ripening before diagnostic procedures. In this study, 45 patients were randomly allocated to estrogen or placebo group. The study group received local estrogen cream and other group received chlindamycine phosphate cream as placebo. The patients were given oral misoprostol 24 and 12 hours before the procedure for uterine cavity evaluation. Cervix was dilated by using Heagar dilator up to 6 mm. Data were analyzed by Student t-test, Mann-Whitney's U-test, chi-square test and paired samples t-test where appropriate. Basal cervical widths for the estrogen and placebo groups were 4.4 +/- 0.7 and 3.7 +/- 0.7 mm, respectively (p < 0.01). Mean time required for dilatation of cervix was 44.4 +/- 16.2 seconds for the estrogen group and 61.4 +/- 18.3 seconds for the placebo group (p < 0.01). As a conclusion, misoprostol treatment alone is not effective to get cervical priming in postmenopausal women, and as shown in our study, pretreatment with local estrogen overcome the failure. To get a beneficial effect of misoprostol on cervical ripening, estrogenic activity is necessary and when pretreated with local estrogen, misoprostol ameliorates cervical priming in postmenopausal women.

What is the role of routine hysteroscopy in the evaluation of uterine cavity in infertile women?

The objective was to determine if hysteroscopy associated to endometrial biopsy should be part of the basic routine investigation of infertile women and to study the incidence of intrauterine abnormalities and associated factors. At the Infertility Clinic of the State University of Campinas, 93 infertile women were prospectively investigated by diagnostic hysteroscopy using a 2.7 or 4.0 mm hysteroscope followed by endometrial biopsy. All patients gave their written informed consent. The associated factors studied were: age, reproductive history, previous pelvic surgery, menstrual cycle characteristics and infertility etiology. Statistical analysis was performed by Fisher's test. In 31 patients (33.3%), hysteroscopy showed an important cervical (4.3%) or intrauterine abnormality. Uterine cavity pathologies were: small uterine cavity size(7.5%); submucous leiomyomas of the uterus (6.4%), polyps (6.4%); uterine malformations (5.4%), and enlarged uterine cavity (4.3%). Endometrial histology diagnosed normal endometrium (87%) and 13% of endometrial abnormalities (endometritis, complex hyperplasia, polyps, leiomyoma). The only factor associated with intrauterine pathology was a previous diagnosis of subserous or intramural leiomyoma of the uterus. Hysteroscopic investigation is an important procedure due to the high incidence of intrauterine pathology (one-third of infertile women) and because these diseases could be treated to enhance the fertility rate. Endometrial biopsy should be indicated as a complementary exam after hysteroscopy to improve the accuracy of endometrium evaluation.

Advantages and disadvantages of hysterosonosalpingography in the assessment of the reproductive status of uterine cavity and fallopian tubes

Background: Hysterosonosalpingography as a contrast ultrasound method is safer, cheaper and easier to perform than hysterosalpingography in the assessment of the uterine cavity and fallopian tubes. Is it feasible for all patients? Which is the main problem in the evaluation of target structures by ultrasound? Methods: In a prospective study, 68 patients in the initial stage of the infertility treatment were examined by hysterosonosalpingography using saline NaCl infundibile ® and Echovist ® as contrast media. Subsequently, further status of the tubes and uterine cavity was assessed by the “gold standards”, laparoscopy and hysteroscopy. Results: Sensitivity and specificity of hysterosonosalpingography using NaCl infundibile ® for evaluation of the uterine cavity was 100 and 88.8%, respectively. Negative predictive value was 100% and positive predictive value 97%. Sensitivity and specificity of the method for the assessment of the tubal status was 100 and 66%, respectively, negative predictive value was 100% and positive predictive value was 61%. For the assessment of tubal patency using positive contrast Echovist ® the method has shown 100% sensibility and negative predictive value again but it reached a specificity of 77% and a positive predictive value of 70%. There were no evident complications during or after the procedure. Conclusion: Hysterosonosalpingography is useful in making decisions regarding further procedures for the diagnosis and treatment of infertility. Uterine cavity evaluation using saline is the method of choice. Tubal patency can be assessed only under ideal sonographic conditions. The method is feasible for early assessment of the reproductive status of uterine cavity and fallopian tubes as a simple, safe and cheap outpatient method prior to any following invasive procedure or even histerosalpingography.

Saline contrast hysterosonography in abnormal uterine bleeding: a systematic review and meta-analysis.

To assess the diagnostic accuracy of saline contrast hysterosonography in the evaluation of the uterine cavity in women complaining of abnormal uterine bleeding. A systematic review and meta-analysis of diagnostic studies that compared saline contrast hysterosonography to a gold standard diagnosis based on either hysteroscopy with or without histological sampling or to hysterectomy. University Hospital. Twenty-four studies (including 2278 procedures). Electronic databases were searched for relevant studies and references were cross checked. Validity was assessed and data were extracted independently by two authors. Heterogeneity was calculated, studies were plotted in an ROC area and data were pooled. Subgroup analysis was performed according to the validity area. The success rate of saline contrast hysterosonography. The pooled sensitivity, specificity, likelihood ratio's and post-test probabilities of saline contrast hysterosonography on the prediction of uterine cavity abnormality. The largest population of homogeneous data were the studies with complete verification. In these studies, the pooled sensitivity and pooled specificity of saline contrast hysterosonography in uterine cavity evaluation were respectively 0.95 (95% CI 0.93 to 0.97) and 0.88 (95% CI 0.85 to 0.92), the likelihood ratios were respectively 8.23 (95% CI 6.2 to 11) and 0.06 (95% CI 0.04 to 0.09) and the post-test probabilities were respectively 0.91 (95% CI 0.89 to 0.94) and 0.07 (95% CI 0.04 to 0.10). The overall success rate of saline contrast hysterosonography was 93% (95% CI 92% to 94%). The feasibility of saline contrast hysterosonography in postmenopausal women (success rate 86.5%, 95% CI 83.2 to 89.8) is significantly lower (P < 0.01) compared with premenopausal women (success rate 95%, 95% CI 94% to 96%). Saline contrast hysterosonography is accurate in the evaluation of the uterine cavity in pre- and postmenopausal women suffering from abnormal uterine bleeding. The feasibility of saline contrast hysterosonography is high, although significantly better in premenopausal women compared with postmenopausal women. We conclude that saline contrast hysterosonography, in combination with an endometrium aspiration if necessary, can become the standard diagnostic procedure in women with abnormal uterine bleeding.