الفهرس 
Introduction.Only 14 pages are availabe for public view
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Abstract
Postmenopusal bleeding is commonly encountered in gynecological practice. It accounts for almost 25% of gynecological operations and 20% of office visits. It requires accurate diagnosis of the cause especially endometrial hyperplasia for the possibility of malignancy transformation and many methods were described for diagnosis. These methods are either non-invasive or invasive techniques. As regards the non-invasive methods, imaging techniques are very helpful in diagnosis, such as pelvic ultrasonography, transvaginal ultrasonography, hysterosalpingogram, sonohysterography, color Doppler and MR1. The objective of this work was to asses the role of transvaginal ultrasound, Doppler velocimetry and hysteroscopy in the diagnosis of postmenopausal bleeding cases by evaluation of the uterine cavity, and to compare the results with an endometrial biopsy obtained by dilatation and curettage. This descriptive study included 30 patients who attended to the out patient clinic of Obstetrics and Gynecology department, Menoufiya University hospital with genital bleeding occuring 12 months or more after the last menstrual period above 50 years (postmenopausal bleeding). Each patient was subjected to the following: - Detailed medical history. - General and abdominal examination was performed to look for the causes of postmenopausal bleeding such as disorders of coagulation, hypothyroidism or hyperthyroidism, liver disease, obesity. - Local Gynecological examination was performed to evaluate of the size, position and mobility of the uterus and to detect masses and tenderness in adnexa and Douglas pouch and to confirm site of bleeding from the uterus and look for any obvious lesions. -Pre operative investigations: -Sonographic examination using: Atransvaginal Ultrasonography and Doppler velocimetry to detect any pelvic pathology (uterinr or adnexal ), measure endometrial thickness and Doppler velocimetry on the subendometrial blood vessels. - Diagnostic Hysteroscopy for direct visualization of the uterine cavity,to detect the criteria of the endometrium . - Dilatation and Curettage biopsy under anaesthesia. - Histopathological examination of the endometrial biopsies. Endometrial thickness of 5mm measured by TVS Was taken as cutt off point 16 cases(53.3 %) had endometrial thickness < 5mm and 14(46.7 %) had endometrial thickness > 5mm. The results of this study suggest that ultrasonographicmeasurement of the ET is not a reliable method for predicting malignant and premalignant histopathological changes of the endometrium postmenopausal women. Although all women with endometrial carcinoma and had ETgreater than 5 mm, yet, ET greater than 5 mm did not exclude atrophicendometrium, as 18.75% of women with atrophic endometrium (N = 16) had ET greater than 5mm. Subendometrial blood vessel RI cut off value of 0.75 chosen and this cut off point had 41% sensitivity , 100% specificity and 90% accuracy with positive predictive value of 100% and negative predictive value of 96% in diagnosis of postmenopausal bleeding. In this study hysteroscopy succeeded in diagnosis of atrophic endometrium in 14 patients and failed to diagnose 2 patients with sensitivity 94% ,specificity 100%, accuracy 97% with positive predictive value of 100% and negative predictive value of 93%, hysteroscopy succeeded in diagnosis of hyperplasia in 2 patients and failed to diagnose 2 patients with sensitivity 100% ,specificity 88%, accuracy 90% with positive predictive value of 57% and negative predictive value of 100%, hysteroscopy succeeded in diagnosis of polyp in 2 patients and didnot fail to diagnose any patients with sensitivity 100% ,specificity 100%, accuracy 100% with positive predictive value of 100% and negative predictive value of 100%, hysteroscopy succeeded in diagnosis of endometritis in 1 patient and failed to diagnose 2 patients with sensitivity 67% ,specificity 100%, accuracy 97% with positive predictive value of 100% and negative predictive value of 96%, hysteroscopy succeeded in diagnosis of carcinoma in 1 patient and failed to diagnose patient with sensitivity 50% ,specificity 100%, accuracy 97% with positive predictive value of 100% and negative predictive value of 97%, hysteroscopy succeeded in diagnosis of submucousmyoma in 3 patients and did not fail to diagnose any patients with sensitivity 100% ,specificity 100%, accuracy 100% with positive predictive value of 100% and negative predictive value of 100%. To conclude endometrial biopsy remains the traditional final proof to diagnose the etiology of PMB. Although hysteroscopy is an effective way to diagnose and treat most cases of BMB. The non invasive TVCD can be considered as initial screening test when hysteroscopy is indicated.