Introduction: Present study comprised of TVS, diagnostic hysteroscopy for diagnosis and histopathology for confirmation of intrauterine pathology. The aim of the study is to narrow down the arrays of investigation, to develop a guideline for quick assessment and hence early management of patients complaining of AUB in a cost effective manner which is essential in this low resource set up women are particularly vulnerable.

Material and Methods: It is a Prospective comparative study for a period of 1.5 years (January 17 to June 18).Women in reproductive and perimenopausal  age complaining of AUB due to suspected intrauterine pathology (either intracavity lesions or pathology in the endometrium) were included in the study for further evaluation by TVS and  hysteroscopy and directed biopsy wherever indicated.

Results: 75 cases were evaluated and most of the cases were multiparous in the age group of 30 -39 years and mean age of intrauterine pathology was 35.5 years. The maximum subject was complaining abnormal uterine bleeding for last 1 – 6 months and 58 % had heavy menstrual bleeding.TVS diagnosed endometrial polyp (32%), endometrial hyperplasia (9%) and submucosal fibroid (14.7%) in maximum patients. Patients diagnosed with hysteroscopy had mainly endometrial polyp (32%), endometrial hyperplasia (24%) and submucosal fibroid (16%).In endometrial hyperplasia, hysteroscopy was more sensitive than TVS, but, probability of the patients for truly have the disease is low in both TVS and hysteroscopy as diagnosed by HP examination. Hysteroscopy diagnosed endometrial polyp much better than TVS with high sensitivity, specificity and predictive values. Submucosal fibroid also diagnosed better by hysteroscopy with good predictive values. Both TVS and hysteroscopy were good diagnostic tools for carcinoma endometrium.

Conclusions: TVS should be continued as 1st line diagnostic tool in patients with AUB. Hysteroscopy is a better diagnostic method for intrauterine pathology in AUB. With combination of both TVS and hysteroscopy, the evaluation for AUB will be more accurate and will guide for appropriate management.

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Dr Arindam Mallik