Assessment of Uterine Cavity and Endometrial Steroid Receptors in Women With Peri- and Post Menopausal Bleeding

Conventional TVUS will be done to all participants to measure the uterine size & endometrial thickness and other pathology. TVUS will be done with an empty bladder in the lithotomy position using an endovaginal curved linear probe (EV 4-9/10 ED) with frequency 4-9 MHz.

SIS will be performed for all patients at the same setting of TVUS. With the patient in the lithotomy position, . A 6 or 8 French Foley's catheter will be inserted through the external cervical os into the cervical canal. Its balloon tip will be inflated with 2-3 mL of saline, depending on patient comfort, to help hold it in place. The speculum was then removed.

The vaginal probe was then reinserted and a 5-10 mL syringe filled with sterile saline was attached to the catheter. Fluid will be instilled while the transducer moved from side to side (cornua to cornua) in a long-axis projection then the transducer was rotated 90° into an axial plane. More fluid was instilled while fanning down toward the endocervical canal and up toward the uterine fundus to obtain a detailed survey of the endometrium. Every portion of the uterine cavity should be imaged, to exclude any focal abnormality as polyps, myomas, hyperplasia, and carcinoma. Any detected intrauterine pathology is described; including its shape, size and site.

The hysteroscope used in this study is a rigid continuous flow panoramic hysteroscope, 25 cm in length, 4 mm in diameter with an outer sheath 5 mm diameter and 30° fibro-optic lens.

The technique used to provide constant uterine distention will be by attaching plastic bags of saline. Infusion pressure was elevated by pneumatic cuff under manometric control at a pressure of 100-120 mmHg.