Diagnostic Accuracy Of 3D Dimensional Sono-hysterography versus Hysteroscopy in The Evaluation of Uterine Cavity in Cases of Perimenopausal Bleeding with Suspected Intra-Cavitary Lesions with Correlation to Histopathological Findings

Background: In the perimenopausal stage, abnormal uterine bleeding (AUB) is the most frequent reason for gynecological appointments. Intrauterine abnormalities are the primary cause of perimenopausal bleeding, aside from dysfunctional uterine bleeding (DUB). The most frequent physical reasons why women experience perimenopausal bleeding are endometrial hyperplasia, endometrial polyps, and submucosal fibroids. Aim and objectives: To determine the relationship between histological results and the diagnostic accuracy of hysteroscopy and three-dimensional sono-hysterography (3D SHG) in instances with perimenopausal hemorrhage with suspected intra-cavitary lesions. Patients and methods: One hundred patients who attended the Obstetrics and Gynecology department at Al-Hussein University Hospitals for six months, from August 2023 to February 2024, were included in this prospective comparison study. Results: In contrast to the hysteroscopy group (22.00 ± 0.75 mm), the 3D SHG group's mean endometrial thickness was lower (18.74 ± 1.22 mm). Compared to premenopausal women's normal endometrial thickness range of 4–8 mm, both groups displayed increased endometrial thickness. This increased thickness indicates the existence of endometrial pathology in both groups and is consistent with the presenting symptom of abnormal uterine bleeding. Conclusion: For perimenopausal women with irregular uterine bleeding, 3D SHG may be as diagnostically accurate as hysteroscopy in identifying intracavitary lesions. Our findings support the potential use of 3D SHG as a first-line diagnostic tool in this population, potentially reducing the need for more invasive and costly procedures.