Value of sonohysterography in the diagnosis and management of abnormal uterine bleeding

PURPOSE: To assess the value of sonohysterography in the diagnosis and management of abnormal uterine bleeding. MATERIALS AND METHODS: Sonohysterography was performed in 28 women (aged 29-55 years) in whom transvaginal sonography (TVS) suggested an abnormal endometrial echo (n=14) or fibroids (n=14). Its effect on diagnosis and treatment was studied. RESULTS: In the patients with an abnormal endometrial echo, sonohysterography depicted endometrial polyps (n=9), intracavitary fibroids (n=3), placental polyp (n=1), and a normal cavity (n=1). Hysteroscopic resection resolved the bleeding in 11 of 14 patients; surgery was obviated in one. In the group with fibroids, sonohysterography depicted small submucous fibroids amenable to hysteroscopic myomectomy (n=5), a small mural fibroid with a normal cavity, which obviated surgical intervention (n=4), and endometrial polyps, which altered the treatment plan (n=1). Sonohysterography suggested the need for an abdominal myomectomy (n=4) and alerted the surgeon to explore the uterine cavity in three patients. CONCLUSION: By helping elucidate the cause of bleeding, sonohysterography assisted in determining the therapeutic approach and often reduced the level of surgical intervention or obviated it altogether.