INTRODUCTION:
Postmenopausal bleeding (PMB) is self-explanatory, as any bleeding from the genital tract occurring in the postmenopausal period, arising after 12 months of amenorrhoea in a women of menopausal age.
Generally, four to 11 per cent of postmenopausal women will experience bleeding while the most common cause for PMB is atrophy, the diagnostic algorithm for PMB is designed to detect cancer, particularly endometrial cancer.
Vaginal, endometrial and urogenital atrophy is par for the course with postmenopausal hypoestrogenism. Atrophy accounts for 60–80 per cent of all causes of PMB, while endometrial hyperplasia and cancer each account for ten per cent of cases.
In Egypt endometrial cancer was diagnosed in 38% of females presenting with PMB study was conducted in Alexandria, Egypt and included all postmenopausal females presenting to the University Hospital of Gynecology and Obstetrics.
The introduction of transvaginal Doppler ultrasound to gynecology has permitted detailed hemodynamic assessment of genital tract tumors and abnormal blood flow peculiar to malignant endometrial changes has been demonstrated in uterine and sub endometrial arteries. Cyclic variations of female pelvic hemodynamics and angiogenesis can be studied with Doppler ultrasound. The power Doppler has a threefold increase in sensitivity compared with conventional color Doppler imaging at detecting low velocity flow.
Endometrial thickness as measured by transvaginal grey-scale sonography can reliably discriminate between normal and pathological endometrium in women with post-menopausal bleeding.