Transvaginal Doppler sonography: is there a role for this modality in the evaluation of women with postmenopausal bleeding?

Objective: The aim of this study was to determine whether transvaginal sonography (TVS) and transvaginal Doppler sonography (TDS) can discriminate between normal and abnormal endometrium. Materials and methods: Patients who had vaginal bleeding an year after menopause and were not on HRT or tamoxifen were preoperatively examined by TVS and TDS on the same day of curettage. The endometrial thickness as well as the pulsatility index (PI) and resistance index (RI) of uterine ateries were recorded. Results: Final pathology analysis revealed that 55/81 (67.9%) had normal endometrial tissue and 26/81 (32.1%) had an abnormality (endometrial hyperplasia, polyp or cancer). The mean endometrial thickness was greater in the abnormal group (9.4 mm versus 3.8 mm, P < 0.05). The mean PI of normal and abnormal endometrium were 2.85 and 1.53. The mean RI of normal and abnormal endometrium were 1.04 and 0.68. Univariate analysis found that PI < 2 and RI < 0.9 were correlated with abnormal endometrium (P < 0.05). Multivariate analysis revealed significance only for the endometrial thickness. Conclusions: TDS cannot distinguish between normal and abnormal endometrium. Using TVS only would result in a significant reduction of endometrial biopsy or curettage.