Association between endometrial thickness on transvaginal ultrasonography and histopathological findings in women with postmenopausal bleeding: A cross-sectional study

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Background: Postmenopausal bleeding is a significant clinical symptom requiring prompt evaluation to exclude endometrial pathology, including hyperplasia and carcinoma. Transvaginal ultrasonography (TVS) is widely used as a non-invasive initial assessment tool, with endometrial thickness serving as an important predictor of underlying histopathological abnormalities. However, variability exists in the correlation between sonographic findings and histopathology. Aim: To assess the association between endometrial thickness measured by transvaginal ultrasonography and histopathological findings in women with postmenopausal bleeding. Materials and Methods: This hospital-based cross-sectional study was conducted among 50 women presenting with postmenopausal bleeding in a tertiary care centre over a period of one year. Detailed clinical evaluation was performed, followed by measurement of endometrial thickness using transvaginal ultrasonography. Endometrial sampling was obtained using Pipelle biopsy or dilatation and curettage, and specimens were subjected to histopathological examination. Data were analyzed using appropriate statistical methods, and association between variables was assessed using the Chi-square test. Results: Among 50 participants, the majority (44%) had endometrial thickness between 5-8 mm. Histopathological examination revealed atrophic endometrium in 32%, proliferative endometrium in 20%, endometrial hyperplasia in 36% (non-atypical 24%, atypical 12%), and carcinoma in 12% of cases. A statistically significant association was observed between increasing endometrial thickness and presence of premalignant and malignant lesions (p<0.001). Most malignant and atypical lesions were seen in women with endometrial thickness >8 mm. Conclusion: Endometrial thickness on transvaginal ultrasonography shows a strong correlation with histopathological findings in postmenopausal bleeding. Increased thickness is significantly associated with premalignant and malignant endometrial pathology, highlighting its importance as a reliable initial screening tool.

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