Goldstein et al used a flow chart to evaluate perimenopausal women with abnormal uterine bleeding. This uses ultrasonography to triage women and to determine further diagnostic tests. The authors are from New York University School of Medicine.
Patient selection: perimenopausal woman > 39 years old with abnormal uterine bleeding (either metrorrhagia or menorrhagia).
Exclusions: A woman on oral contraceptives, hormone supplementation, or with a positive pregnancy test
Step 1: Endovaginal ultrasound performed on day 4-6 of bleeding episode (time of minimum endometrial thickness)
If the endometrial layer is <= 5 mm, then diagnose dysfunctional uterine bleeding.
Step 2: If the endometrial layer is > 5 mm or not adequately visualized, then perform saline infusion sonohysterography.
Parameters seen on saline infusion sonohysterography:
(1) thickness
(2) symmetry
(3) focal defects
Endometrial Thickness
Symmetry of Endometrium
Focal Lesion
Diagnosis or Action
<= 3 mm
symmetrical
none
Dx dysfunctional uterine bleeding
> 3 mm
symmetrical
none
perform an office endometrial biopsy
NA
asymmetrical
NA
perform D&C, hysteroscopy
NA
NA
present
perform D&C, hysteroscopy
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