Role of sonohysterography in diagnosis of perimenopausal bleeding

Saline infusion sonohysterography is a procedure in which warm saline is instilled into the uterine cavity to provide enhanced endometrial visualization during transvaginal ultrasound. This technique improves detection of endometrial pathology, such as polyps, leiomyomas, hyperplasia, cancer, and adhesions. In addition, it helps avoid invasive diagnostic procedures as well as optimize the preoperative triage process for women requiring therapeutic intervention. It is easily and rapidly performed at reasonable cost, well tolerated, and virtually devoid of complications. Sonohysterography is particularly useful for finding focal endometrial abnormalities or further confirming and defining the pathologic nature of a potential abnormality detected by ultrasound. Abnormal uterine bleeding is a common gynecologic complaint and it may involve females at any age group. Thirty-three percent (33%) of women referred to gynecologic clinics have abnormal bleeding and this figure rises to 69% in premenopausal and postmenopausal women. Sonohysterography is typically indicated in premenopausal women with abnormal uterine bleeding because it can distinguish anovulatory dysfunctional uterine bleeding, which is best treated hormonally or by endometrial ablation, from an anatomic lesion, which may require tissue sampling and/or resection for treatment. Despite the wide spread use of TVS for initial evaluation of AUB, the number of studies in the literature is growing which indicate that TVS has its limitations in depicting small nodular lesions, which are isoechoic within the endometrium, and even a normal thickness endometrium may be seen to represent endometrial hyperplasia.