Pelvic ultrasound and histopathological findings in post-menopausal patients with uterine bleeding in Western Kenya

Background: Post-menopausal bleeding is a common gynecologic problem accounting for a significant number of yearly visits to our outpatient gynecologic clinic. Ultrasound in comparison with histopathology aids in the early diagnosis of possible causes. Objective: To ascertain the diagnostic accuracy of pelvic ultrasonography in patients with postmenopausal bleeding in our hospital. Methods: This was a descriptive cross-sectional study done between July 2017 and June 2018 at Moi Teaching and Referral Hospital. Consecutive sampling on consenting patients presenting with a clinical diagnosis of post-menopausal bleeding was done. A total of 67 participants were included. A structured questionnaire was administered to the participants. Categorical data was summarized as well as continuous variables. Data analysis and statistical computing was done. Results: The mean age was at 54.6 years. The years post menopause ranged from 1-15 years with a mean age of 4.6 years. There were 31 (46.2%) participants with endometrial thickness greater than 5mm. Uterine fibroids in 2 participants while endometrial fluid was seen in 2 participamts. On histopathological diagnosis, atrophic endometritis accounted for 48% of the cases. Endometrial hyperplasia was at 22%, endometrial carcinoma at 13%, chronic endometritis 8%, endometrial polyp 6% and unremarkable (normal) diagnosis at 3%. A level of agreement for malignancy calculated was found to be 57%. Conclusion: Increase in endometrial thickness is associated with an increased risk in malignancy. The level of agreement between ultrasound and histopathology is low at 53 %.