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ABSTRACT Background: Postmenopausal bleeding is a common clinical problem and may indicate serious endometrial pathology. Transvaginal ultrasonography (TVUSG) is a widely used, non-invasive diagnostic tool for evaluating endometrial thickness. Methods: This prosspective cohort study was conducted at S.B. Haseki Training and Research Hospital between September1996 and Julay1997. Forty postmenopausal women with uterine bleeding who underwent both TVUSG and histopathological evaluation were included. Endometrial thickness was measured, and results were compared with histopathology. Sensitivity, specificity, and ROC analysis were calculated. Results: Endometrial thickness was ≤6 mm in 19 patients (47.5%), none of whom had pathological findings, and >6 mm in 21 patients (52.5%), 14 of whom (66.7%) had pathological results. TVUSG demonstrated 100% sensitivity, 73% specificity, 66% positive predictive value, and 100% negative predictive value in detecting endometrial pathology. The most frequent histopathological findings were insufficient material (25%), atrophic endometrium (15%), proliferative endometrium (15%), chronic endometritis (10%), endometrial polyp (10%), endometrial hyperplasia (15%), and endometrial carcinoma (10%). ROC analysis confirmed 6 mm as the most reliable cut-off value, with a specificity of 73%. Conclusion: Transvaginal ultrasonography (TVUSG) demonstrates reliable diagnostic performance in postmenopausal women presenting with vaginal bleeding. An endometrial thickness cut-off of 6 mm reliably distinguishes women at low risk of pathology from those requiring further histopathological evaluation, providing a non-invasive and cost-effective first-line diagnostic approach that may reduce unnecessary invasive procedures.
