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Abstract To analyze the clinical diagnostic value of hysteroscopy combined with transvaginal ultrasound for abnormal uterine bleeding and etiology of abnormal uterine bleeding of perimenopausal women. Methods: A total of 90 perimenopausal women with abnormal uterine bleeding were selected as the research objects from May 2019 to March 2021. All these women were examined by hysteroscopy and transvaginal ultrasound. With the pathological diagnosis as the "gold standard", the diagnostic efficiency for abnormal uterine bleeding of the perimenopausal women were analyzed and compared between hysteroscopy and transvaginal ultrasound. Results: The coincidence rate of hysteroscopy and transvaginal ultrasound for diagnosing normal endometrial was 83.3% and 66.7%. The coincidence rate of hysteroscopy and transvaginal ultrasound for diagnosing endometrial polyp diagnosis was 91.7% and 75.0%. The coincidence rate of hysteroscopy and transvaginal ultrasound for diagnosing endometrial hyperplasia was 88.5% and 80.8%. The coincidence rate of hysteroscopy and transvaginal ultrasound for diagnosing submucosal myoma was 100.0% and 80.0%. The coincidence rate of hysteroscopy and transvaginal ultrasound for diagnosing atypical hyperplasia diagnosis was 80.0% and 60.0%. The coincidence rate of hysteroscopy and transvaginal ultrasound for diagnosing endometrial cancer diagnosis was 87.5% and 75.0%. The coincidence rate of hysteroscopy for diagnosing abnormal uterine bleeding was 86.7%, which was significantly higher than that (73.3%) of transvaginal ultrasonography (P=0.025). Receiver operating characteristic curve analysis showed that, the area under the curve (AUC) of hysteroscopy, transvaginal ultrasound，and hysteroscopy combined with transvaginal ultrasound for diagnosing normal intima were 0.815, 0.682, 0.882, respectively, the sensitivity of which were 84.9%, 78.3%, 87.3%, respectively, and the specificity of which were 70.6%, 70.6%, 79.9%. The AUC of hysteroscopy, transvaginal ultrasound，and hysteroscopy combined with transvaginal ultrasound for diagnosing endometrial polyp were 0.764, 0.674, 0.894, respectively, the sensitivity of which were 80.3%, 76.4%, 84.4%, respectively, and the specificity of which were 71.3%, 69.9%, 80.1%, respectively. The AUC of hysteroscopy, transvaginal ultrasound，and hysteroscopy combined with transvaginal ultrasound for diagnosing endometrial hyperplasia were 0.716, 0.722, 0.905, respectively, the sensitivity of which were 85.6%, 80.2%, 91.2%, respectively, and the specificity w of which were 80.2%, 72.6%, 85.5%, respectively. The AUC of hysteroscopy, transvaginal ultrasound，and hysteroscopy combined with transvaginal ultrasound for diagnosing submucosal myoma were 0.824, 0.719, 0.952, the sensitivity of which were 81.3%, 79.1%, 92.7%, respectively, and the specificity of which were 75.1%, 71.6%, 86.1%, respectively. The AUC of hysteroscopy, transvaginal ultrasound，and hysteroscopy combined with transvaginal ultrasound for diagnosing dysplasia was 0.782, 0.677, 0.927, respectively, the sensitivity of which were the sensitivity was 79.3%, 76.9%, 93.0%, respectively, and the specificity of which were 69.9%, 70.0%, 86.2%, respectively. The AUC of hysteroscopy, transvaginal ultrasound，and hysteroscopy combined with transvaginal ultrasound for diagnosing endometrial carcinoma were 0.791, 0.669, 0.919, respectively, the sensitivity of which were 80.0%, 76.9%, 91.0%, respectively, the specificity of which were 74.1%, 71.7%, 84.3%, respectively. Conclusion: Hysteroscopy combined with transvaginal ultrasound has high diagnostic values for abnormal uterine bleeding and etiology of abnormal uterine bleeding of the perimenopausal women.
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