Imaging techniques in the management of abnormal vaginal bleeding in non-pregnant women before and after menopause

Transvaginal ultrasound plays a pivotal role in the management of non-pregnant women with abnormal vaginal bleeding. No other imaging technique has a role in the triage of these women. In women with postmenopausal bleeding, ultrasound is used to categorise women as at low or high risk of endometrial cancer, and the result of the ultrasound examination is the basis for further management. In women with abnormal vaginal bleeding before the menopause, the role of ultrasound is less clear. This is because some common causes of abnormal vaginal bleeding before the menopause cannot be diagnosed with ultrasound, such as infection, dysfunctional bleeding, or problems with intrauterine contraceptive devices or contraceptive pills. Nonetheless, transvaginal ultrasound may also sometimes be helpful in women with abnormal vaginal bleeding before the menopause. In this chapter, I present ultrasound findings in women with endometrial cancer, endometrial polyps, endometrial hyperplasia, adenomyosis, uterine myomas, including submucous myomas and leiomyosarcoma, and describe ultrasound-based triage of women with postmenopausal bleeding.