Transvaginal ultrasound with SIS is a cost-minimizing screening tool for perimenopausal and postmenopausal @entity1 with @entity3556 . Its use decreases the need for invasive diagnostic procedures for @entity1 without abnormalities, and ultrasound increases the sensitivity of detecting abnormalities in @entity1 with pathologic conditions. Vaginal sonography is preferred over uniform biopsy of postmenopausal @entity1 with @entity3556 because it (1) is a less invasive procedure, (2) is generally painless, (3) has no complications, and (4) may be more sensitive for detecting @entity189 than blind biopsy. Transvaginal sonography is rarely nondiagnostic. Endometrial sampling is less successful in @entity1 with a thin endometrial stripe on ultrasound than in @entity1 with real endometrial pathologic condition. A limitation of ultrasound is that an abnormal finding is not specific: ultrasound cannot always reliably distinguish between benign proliferation, @entity1373 , @entity1127 , and @entity5 . Although ultrasound may not be able to distinguish between @entity1373 and @entity5 , the next step in the clinical treatment requires tissue sampling. Because of the risk of progression of @entity189 , @entity1 with this finding may benefit from hormonal suppression, dilatation and curettage, endometrial ablation, or hysterectomy, depending on the clinical scenario. The inability to distinguish these two entities based on ultrasound alone should not be seen as a limitation because tissue sampling is required in either case. Occasionally (in 5% to 10% of cases), a @entity1 's endometrium cannot be identified on ultrasound, and these @entity1 also need further evaluation. Ultrasonography also may be used as a first-line investigation in other populations with abnormal uterine @entity548 . In a multicenter, randomized, controlled trial of 400 @entity1 with abnormal uterine @entity548 , the investigators found that transvaginal sonography combined with Pipelle endometrial biopsy and outpatient hysteroscopy was as effective as inpatient hysteroscopy and curettage. The subject, included @entity1 older than 35 years with PMB, @entity931 , @entity1867 , @entity548 , or irregular menses. Transvaginal sonography may be a cost-effective. sensitive, and well-tolerated method to evaluate most @entity1 with @entity548 in combination with physical examination and endometrial biopsy and hysteroscopy us indicated. Hysteroscopy is likely to become the new gold standard in the future because of its ability to visualize directly the endometrium and perform directed biopsies as indicated. As office-based hysteroscopy becomes more practical and widespread, the technique may become more cost effective. An evaluation plan using transvaginal sonography as the initial screening evaluation followed by endometrial biopsy or, more likely, hysteroscopy is likely to become the standard of care (Fig. 12). It remains unproven whether certain @entity1 at higher risk for @entity189 should proceed directly to invasive evaluation. @entity1 on @entity440 with persistent recurrent @entity548 , @entity1 with significant risk factors for @entity189 , and @entity1 with life-threatening @entity548 comprise this group. Further studies are still necessary to evaluate high-risk @entity1 and determine whether ultrasound or biopsy is really the most cost-effective initial test.

Ultrasonographic evaluation of the endometrium in postmenopausal XXXX .

@entity1 :: ('9606', 'Species') :: ['women', 'woman', 'patients', 'Women'] @entity3556 :: ('MESH:D014592', 'Disease') :: ['vaginal bleeding'] @entity1127 :: ('MESH:D011127', 'Disease') :: ['polyps'] @entity548 :: ('MESH:D006470', 'Disease') :: ['abnormal bleeding', 'postcoital bleeding', 'bleeding', 'hemorrhage'] @entity440 :: ('MESH:D013629', 'Chemical') :: ['tamoxifen'] @entity5 :: ('MESH:D009369', 'Disease') :: ['cancer', 'malignancy'] @entity1373 :: ('MESH:D006965', 'Disease') :: ['hyperplasia'] @entity189 :: ('MESH:D002277', 'Disease') :: ['complex hyperplasia to carcinoma', 'carcinoma'] @entity1867 :: ('MESH:D008796', 'Disease') :: ['intermenstrual bleeding'] @entity931 :: ('MESH:D008595', 'Disease') :: ['menorrhagia']
@entity3556 :: (MESH:D014592,Disease) :: ['vaginal bleeding']
