L’apport de l’échographie dans l’exploration des métrorragies post-ménopausiques

Post-menopausal metrorrhagias represent a frequent reason for consultation in gynecology. Our study aims to evaluate the contribution of pelvic ultrasonography in the exploration of endocavitary lesions in people experiencing this symptom and to compare the results found with those of hysteroscopy and histology. This was an analytic retrospective study of 33 cases referred for evaluation of postmenopausal metrorrhagias at the department of gynecology and obstetrics «A» in the Center of Maternity and Neonatology of Tunis in 2012. All patients underwent pelvic ultrasonography and diagnostic hysteroscopy. We analyzed and compare the data obtained with pelvic ultrasonography, hysteroscopy and histological examination. The average age of our patients was 57.78 years and the average age of menopause was 48.36 years. The confrontation between ultrasonographic and histological data showed that ultrasonography has a sensitivity of 80.6%, a specificity of 79.38%, positive predictive value (PPV) of 67.03% and negative predictive value (NPV) of 91.54%. With respect to hysteroscopy these values were 84,44%, 82,72%, 69,93% and 92,65% respectively. Performance level for each exploratory diagnostic tool varied according to the lesion which caused metrorrhagias and generally hysteroscopy was more reliable in the exploration of metrorrhagias than ultrasonography: Youden index 0.67 against 0.59. Our results confirmed data published in the literature that assigns to hysteroscopy a greater reliability compared to pelvic ultrasonography in the diagnosis of endocavitary lesions causing postmenopausal metrorrhagias.