The role of transvaginal sonography and endometrial biopsy in the evaluation of peri- and postmenopausal bleeding.

The number of women seeking medical attention for peri- and postmenopausal bleeding (PMB) has been increasing. Determining the cause of PMB is essential in planning appropriate therapy. In these women, transvaginal sonography (TVS) is a sensitive means for diagnosing the causes of such bleeding, yet endometrial biopsy (EMB) is still preferred as the first diagnostic test. We prospectively compared TVS with aspiration biopsies of the endometrium in the examination of women with PMB.Between mid April 1994 and December 1995, 329 consecutive perimenopausal women underwent EMB. Of these EMBs 302 had negative results. We prospectively obtained TVS in 259 of these 302 women within 1 month of EMB (range, 10 days to 2 months) when the results of biopsy were negative. Forty-three patients were lost to follow-up. In 59 women who had endometrial thickening greater than 5 mm, dilatation and curettage, hysteroscopy, or hysterectomy was performed. Ninety-four of the 130 women who were found at TVS to have fibromyomata o...