Diagnostic Value Of Hysteroscopy Combined With Transvaginal Ultrasound In Perimenopausal Abnormal Uterine Bleeding

Background abnormal uterine bleeding(AUB)in perimenopause refers to a period of gradual decline in ovarian function until one year after menopause.The main clinical manifestations include menorrhagia,oligomenorrhea,shortened menstrual cycle,prolonged menstrual cycle,prolonged menstrual cycle,irregular bleeding and so on.Long-term perimenopausal bleeding can lead to some adverse reactions,including iron deficiency anemia,abdominal pain,pelvic inflammation and dyspenorrhea,which have a serious impact on women’s daily work and life,leading to a serious decline in their quality of life.It is very important to identify the cause of abnormal uterine bleeding as early as possible for early prevention and treatment.Objective To investigate the diagnostic value of hysteroscopy combined with transvaginal ultrasound in abnormal uterine bleeding during perimenopause.Methods A total of 305 perimenopausal patients admitted to the Department of Gynecology of Renhe Hospital Affiliated to China Three Gorges University from January2019 to June 2022 due to abnormal uterine bleeding were retrospectively analyzed.They were divided into two groups: benign lesion group and malignant lesion group.General clinical data,hysteroscopy and pathological data of the two groups were collected and recorded.SPSS26.0 software was used for statistical processing of the data,and various indicators of the benign lesion group and the malignant lesion group were analyzed.To evaluate the diagnostic value of hysteroscopy,transvaginal ultrasonography and their combination for abnormal uterine bleeding in perimenopausal period by receiveroperating Characterisic curve(ROC curve).Result(1)Pathological data of 305 patients showed that benign lesions were the main pathological types,accounting for 82.6%(252/305);Malignant lesions accounted for only17.4%(53/305)of the total sample size.There were 8 pathologic types of benign lesions,among which endometrial polyps were more common,and atrophic endometrium accounted for the least proportion.(2)The overall coincidence rate of hysteroscopy was 90.2%,and the overall coincidence rate of transvaginal ultrasound was 75.4%.Chi-square test showed that the detection rate of hysteroscopy(χ2=4.010,P =0.045)was higher than that of transvaginal ultrasound,and the difference was statistically significant.(3)The accuracy of hysteroscopy diagnosis of endometrial polyps,endometrial hyperplasia,uterine fibroids,atypical hyperplasia and endometrial cancer is better than that of transvaginal ultrasound diagnosis.The accuracy of diagnosis of endometrial polyps,endometrial hyperplasia,uterine fibroids,atypical hyperplasia and endometrial cancer by hysteroscopy combined with transvaginal ultrasound is better than that by hysteroscopy alone or transvaginal ultrasound.Transvaginal ultrasonography had the highest sensitivity in the diagnosis of endometrial hyperplasia.Hysteroscopy has the highest sensitivity in the diagnosis of myoma.The sensitivity of hysteroscopy combined with transvaginal ultrasound in the diagnosis of uterine fibroids is the highest.Conclusion(1)The sensitivity and specificity of hysteroscopy in the diagnosis of the cause of abnormal uterine bleeding in perimenopause are higher than transvaginal ultrasound,and the combined hysteroscopy and transvaginal ultrasound can further improve the accuracy of diagnosis.(2)For patients with abnormal uterine bleeding,hysteroscopy can be used to visually observe the size,shape and bleeding of the lesion;Vaginal endoscopy has the characteristics of less pain,minimally invasive,no bleeding and clear vision,which is worthy of clinical promotion.