الفهرس 
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Abstract
bleeding is a well known alarming symptom simply because it may be a manifestation of an underlying malignancy. The need for careful evaluation in every case is well recognized. It was previously known that postmenopausal bleeding indicates a malignant disease until proved to be otherwise but many recent reports stressed the importance of several benign causes for postmenopausal bleeding.
Considering cessation of menstruation as .the cardinal symptom of menopause, postmenopausal bleeding is refereed to any vaginal bleeding that is reported after complete stoppage of menstruation. Controversy is present in the minimum required period following the last menses, before designating the bleeding as postmenopausal. This period varies from six months to two years with a mean of one year.
This study has been conducted on 100 menopausal patients with postmenopausal bleeding to evaluate the role of transvaginal ultrasonography as a non invasive technique in studying the endometrium in cases of postmenopausal bleeding in comparison with histopathologic endometrial studying of this cases.
The results of this thesis can be summarized as follows:
The age of onset of menopause ranging from 42-55 years, with a mean of 48.53 and a S.D of± 3.32 years, when the endometrial thickness ≤ 4mm . The age of onset of menopause ranging from 43-61 with a mean of 50.40 and a S.D of 4.14 when the endometrial thickness > 4mm .
The age of occurrence of bleeding ranging from 45-71 years with a mean of 54.27 and S.D of 7.36 when the endometrial thickness ≤ 4mm. The age of occurrence of bleeding ranging from 45-81 years with a mean of 58.49 and S.D of 9.44 when the endometrial thickness > 4 mm. The years elapsed between :he onset of menopause and the onset of bleeding ranging from 1-16 years with a mean of 5.73 and S.D of+ 4.43. when the endometrial thickness ≤4mm. The years elapsed between, he onset of menopause and the onset of bleeding ranging from 1-20 years with a mean of 8.09 and S.D of+ 5.76. when the endometrial thickness > 4mm.
The endometrial histopathological examination of the studies showed 30 patients with atrophic endometrium (30%), 12 patients.
With secretory endometrium hyperplasia(12 %) and 28 cases with Adenomatous hyperplasia 28 % and 14 cases with endometrial carcinoma (14%) and 4 cases with Chronic endometritis 4% and 8 cases Cystic glandular hyperplasia with atypia 8 % and 4 cases with endometrial polyp 4 %.
By using ≤4mm endometrial thickness as a cut off value which is the chosen cut off value for our standard in the diagnosis upper limit of atrophic endometrium. The diagnosis of atrophic endometrium was matched with the histopathology in 24 cases of 30 cases .and no cases of endometrial carcinoma and hyperplasia was diagnosed by histopathology .in using > 4mm, endometrial thickness as a cut off value 14 cases was diagnosed with endometrial carcinoma 14 % and 6 cases as atrophic endometrium 6 % and 4 cases as chronic endometritis 4 % and 8 cases.
Cystic glandular hyperplasia with atypia 8 % and 4 cases endometrial polyp 4 %. Upon the previous results transvaginal ultrasonography can be considered as a fairly simple non-invasive technique in the diagnosis of endometrial abnormalities in cases of postmenopasual bleeding with the use of high frequency transvaginal ultrasonography (6.5) MH. The endometrium can be easily visualized and its thickness could be easily measured. 4mm endometrial thickness is recommended as a cut off value below which endometrial abnormalities could be excluded and above it endometrial abnormalities to be expected with the need for using other diagnostic complementary technique as histopathologic evaluation to establish the diagnosis.