Role of Transvaginal Ultrasonography in Evaluation of Abnormal Uterine Bleeding in Perimenopausal Women: A Retrospective Observational Study

Abstract

Background: Abnormal uterine bleeding (AUB) is one of the most frequent gynecological complaints among perimenopausal women and accounts for a substantial proportion of outpatient visits and gynecological interventions. During the perimenopausal transition, hormonal fluctuations often result in menstrual irregularities; however, structural uterine lesions, endometrial hyperplasia, and endometrial carcinoma must be excluded because of their significant clinical implications. Transvaginal ultrasonography (TVS) has become the preferred first-line imaging modality for evaluating women with AUB owing to its high-resolution visualization of the uterus, endometrium, and adnexa. Accurate assessment of endometrial thickness and uterine morphology facilitates early diagnosis and guides the need for further invasive investigations such as hysteroscopy or endometrial biopsy.
Objectives: To evaluate the role of transvaginal ultrasonography in identifying the causes of abnormal uterine bleeding among perimenopausal women and to analyze the ultrasonographic findings in relation to clinical presentation and histopathological diagnosis.
Methodology: A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology, Vyas Medical College, Jodhpur. Medical records of 430 perimenopausal women presenting with abnormal uterine bleeding between January 2025 and December 2025 were reviewed. Demographic characteristics, menstrual history, ultrasonographic findings, endometrial thickness, associated pelvic pathology, histopathological reports, and management details were extracted from hospital records. Statistical analysis was performed using IBM SPSS Statistics Version 26.0. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. Appropriate statistical tests were applied, and a p-value <0.05 was considered statistically significant.
Results: A total of 430 perimenopausal women with abnormal uterine bleeding were included in the study. The mean age was 45.8 ± 3.2 years, with the highest proportion of patients belonging to the 46–50 years age group (44.2%). Heavy menstrual bleeding (37.2%) was the most common presenting complaint, followed by irregular menstrual bleeding (26.3%). On transvaginal ultrasonography, endometrial hyperplasia (29.8%) was the most frequent finding, followed by fibroid uterus (25.6%), adenomyosis (15.8%), endometrial polyp (10.5%), and thickened endometrium >12 mm (8.4%), while 4.4% of women had no significant ultrasonographic abnormality. The mean endometrial thickness was 10.8 ± 3.6 mm, and women with significant endometrial pathology had significantly greater endometrial thickness (p < 0.001). Transvaginal ultrasonography demonstrated high diagnostic performance for detecting significant endometrial pathology, with a sensitivity of 91.4%, specificity of 88.2%, positive predictive value of 86.5%, negative predictive value of 92.6%, and overall diagnostic accuracy of 89.8%. Histopathological correlation showed high concordance between TVS findings and the final diagnosis, supporting its reliability as a first-line diagnostic modality.
Conclusion: Transvaginal ultrasonography is an effective, non-invasive, and reliable first-line diagnostic modality for evaluating abnormal uterine bleeding in perimenopausal women. It accurately identifies common uterine pathologies, assists in risk stratification based on endometrial thickness, and facilitates timely selection of patients requiring histopathological evaluation.