Ultrasonography, hysteroscopy or both?

Summary

Ultrasonography and hysteroscopy are widely used in investigation of abnormal uterine bleeding, but there is much debate about their relative merits. To determine whether ultrasonography alone, hysteroscopy alone, or both are necessary for making optimum management decisions we studied the records of 100 randomly selected patients presenting with various forms of abnormal uterine bleeding. Management based on ultrasonography or hysteroscopy alone agreed in 45·5 to 75 per cent of patients depending on age and symptomatology. Ultrasound correctly predicted planned management in 9·5 to 33·3 per cent of cases which were missed by hysteroscopy alone, while hysteroscopy identified 7·1 to 30 per cent of suggested treatments not forecast after ultrasound alone. Compared with the results of both investigations, management based solely on ultrasound scanning or hysteroscopy disagreed with 7·1 to 36·4 per cent and 12·5 to 33·3 per cent of treatment plans respectively depending on patient age and symptoms. Our results show that pelvic ultrasonography and diagnostic hysteroscopy provide complimentary information regarding patient management and should both be utilised for the optimum assessment of menstrual symptoms.