الفهرس 
Anatomy of the uterusOnly 14 pages are availabe for public view
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Abstract
Menopause is derived from the Greek words, men (month) and pause (cessation). Menopause is defined as the permanent cessation of menses for more than one year and is physiologically correlated with the decline in estrogen secretion resulting from the loss of follicular function. So postmenopausal bleeding is defined as bleeding from the genital tract after the cessation of menstruation for more than one year. It is one of the most common problems affecting women after menopause.
Menopause occurs at a median age of 51 years. The age of menopause appears to be determined genetically & does not seen to be related to race, nutritional status, age of menarche. However it may occur earlier in cigarette smokers, in women, who have had hysterectomies & in nulliparous women.
Postmenopausal bleeding requires careful evaluation to-detect the cause of bleeding as it is often the first and principal symptom of endometrial cancer. It should be regarded as a symptom of genital tract malignancy until proved otherwise. For this reason any amount of bleeding from the genital tract should be etiologically, anatomically and pathologically explained so that the exact diagnosis can be reached in any case of postmenopausal bleeding. It would be therefore valuable to evaluate the role of simple non invasive methods for diagnosis of endometrial abnormalities in cases of postmenopausal bleeding (as transvaginal Ultrasonography and Doppler velocimetric studies)
Its main causes are the use of exogenous estrogen as a hormonal replacement therapy, atrophic endometritis and vaginitis, endometrial cancer, endometrial or cervical polyps, endometrial hyperplasia and miscellaneous (e.g., cervical and ovarian cancers, uterine sarcoma, urethral caruncle, trauma).
The purpose of this study is to assess the value of examination using transvaginal Ultrasonography and Doppler velocimetric study of the uterine artery to increase the diagnostic accuracy in cases with postmenopausal bleeding .
Transvaginal Ultrasonography is a simple noninvasive diagnostic method that can be used in detecting abnormal endometrium in patients with postmenopausal bleeding.
The introduction of high frequency transvaginal ultrasound improved the ability to assess pelvic organs and study morphological changes in details because of the close proximity of the vaginal probe to the structures being studied. Ultrasonic examination of the uterus in postmenopausal women has become very easy and quick and the endometrium can be depicted with great details.
Recently 3D ultrasound evolution overcomes 2D ultrasound in evaluation of uterine cavity and diagnosis of endometrial polyp.
Measurement of endometrial volume ( 3D U/S) overcome endometrial carcinoma in cases of postmenopausal bleeding and in diagnosis of spread of endometrial carcinoma to the myometrium and to the cervix.
Doppler velocimetry is another simple noninvasive technique that uses high frequency sound for investigations of the blood flow which represents the most recent development in ultrasound assessment of gynecological patient.
Recently, duplex method has been used to study the flow pattern in the uterine artery and its smaller tributaries with its correlation to endometrial histopathology in cases with abnormal uterine bleeding.
The present study emphasizes the importance of the examination using both techniques to increase the diagnostic accuracy and to decrease as much as possible the false results that may occur in either of them alone.
It is recommended to take 5 mm endometrial thickness and 0.85 uterine artery RI as a cut-off value to detect endometrial pathology.