THE ROLE OF TRANSABDOMINAL AND TRANSVAGINAL ULTRASOUND IN DETECTING ENDOMETRIAL HYPERPLASIA IN PERIMENOPAUSAL AND POSTMENOPAUSAL WOMEN

Background: Endometrial hyperplasia (EH) is a frequently encountered gynecological disorder marked by abnormal proliferation of the endometrial lining, often due to prolonged estrogen stimulation without progesterone opposition. It is a precursor to endometrial carcinoma, particularly in high-risk groups such as perimenopausal and postmenopausal women. Abnormal uterine bleeding is the most common clinical presentation. While transvaginal sonography (TVS) and transabdominal sonography (TAS) are routinely used for endometrial evaluation, their diagnostic reliability remains debated. Objective: To assess the effectiveness of TVS and TAS in identifying endometrial hyperplasia in perimenopausal and postmenopausal women presenting with abnormal uterine bleeding. Methods: A descriptive cross-sectional study was conducted at DHQ Hospital Kasur over three months following ethical approval. A total of 122 women aged ≥40 years, either perimenopausal or postmenopausal, presenting with abnormal uterine bleeding were included using non-probability convenient sampling. Exclusion criteria were recent pregnancy, confirmed malignancy, chemo/radiotherapy, and uterine fibroids. All participants underwent ultrasound using Toshiba Nemio XG equipment—TAS with a 2–5 MHz probe and TVS with a 5–9 MHz probe. Endometrial thickness, echotexture, and clinical symptoms were recorded. Data were analyzed using SPSS v25.0 to calculate sensitivity, specificity, and predictive values. Results: Out of 122 participants, 71 (58.2%) were below 50 years and 88 (72.1%) were postmenopausal. Clinical symptoms included pelvic pain (74.6%), heavy bleeding (64.8%), and spotting (35.2%). TAS was performed in 113 cases (92.6%) and TVS in 19 cases (15.6%). Abnormal endometrial thickness was observed in 75 women (61.5%). TVS showed a sensitivity of 100% and specificity of 32.9%, while TAS demonstrated 40% sensitivity and 96.3% specificity. Positive and negative predictive values of TAS were 84.2% and 76.7%, respectively. No statistically significant association was found between clinical symptoms or menopausal status and ultrasound findings (p > 0.05). Conclusion: Although both TVS and TAS detect endometrial abnormalities, neither modality alone effectively predicts clinical symptom patterns or endometrial thickness. TVS is more suitable for detecting abnormalities, while TAS provides better specificity. A combined diagnostic strategy is advised to ensure accurate assessment and management.