Most gynecologists who treat postmenopausal patients encounter the need to evaluate and determine the causes of postmenopausal bleeding. Indeed, about 70 percent of visits to gynecologists are due to abnormal uterine bleeding, according to New York-based gynecologist Dr. Steven Goldstein. These patients require prompt and thorough examination to rule out potential causes.
Common Causes of Postmenopausal Bleeding
As Dr. Goldstein said, "Postmenopausal bleeding should be considered to be uterine cancer until proven otherwise." According to The American Congress of Obstetrics and Gynecology, bleeding is the presenting sign in more than 90 percent of women with uterine cancer. However, only about 1 to 14 percent of women with postmenopausal bleeding will have this disease. Instead, the majority of women with bleeding experience it secondary to age-related atrophic changes to the vagina or endometrium, according to the Tawianese Journal of Obstetrics and Gynecology.
Women who take hormone replacement therapy can also develop postmenopausal bleeding, possibly because the endometrium is sensitive to estrogen. Other causes include polyps, fibroids, hyperplasia and infections of the uterus or cervix.
The Benefits of 3D Transvaginal Ultrasound
Even though uterine cancer is a less common cause of postmenopausal bleeding, it is a serious enough concern to warrant examination. The two main methods of evaluating postmenopausal bleeding are transvaginal ultrasound and endometrial biopsy. While biopsy can confirm imaging results, 3D transvaginal ultrasound is the best approach to assess postmenopausal bleeding.
Unlike standard 2D images, 3D ultrasound technology can reconstruct the coronal plane. This creates ultrasound images that more realistically represent the internal organs, including the uterus. According to research published in Ultrasonography, 3D ultrasound is more useful than 2D technology at identifying causes of postmenopausal bleeding such as fibroid tumors and endometrial polyps. It can also detect uterine adhesions more effectively than a hysterosalpingogram.
3D U/S uterine pathology
Additionally, 3D ultrasound can accurately identify endometrial thickness. The thickness of the endometrial lining is a key differentiator in cases of uterine cancer. Dr. Goldstein explained that the thicker the lining, the greater the likelihood of cancer. Transvaginal ultrasound can also show whether the endometrial lining is very thin, which can indicate endometrial atrophy as a cause of bleeding.
Finally, 3D transvaginal ultrasound has a very high negative predictive value, which means it can be used to rule out uterine cancer right away. This saves time and may eliminate patient anxiety, and it allows the physician to move on to other possible causes of postmenopausal bleeding immediately.
Enhancing Patient Care With Improved Diagnosis
Simply put, 3D transvaginal ultrasound can help gynecologists improve patient care by enhancing the process of evaluation and diagnosis. As Dr. Goldstein said, "Performing ultrasound first on women who present with postmenopausal bleeding is sound judgment for gynecologists."
