Test	Utility	Limitations or contraindications	Effectiveness
Endometrial biopsy	Readily available Low complication rate²⁸	Pregnancy Active pelvic inflammatory disease Clotting disorders Cervical infection or pathology²⁸	91 percent sensitive and 98 percent specific for detecting cancer²⁹
Endometrial biopsy	Readily available Low complication rate²⁸		82.3 percent sensitive and 98 percent specific for detecting hyperplasia with atypia²⁹
Office hysteroscopy	Direct visualization of the uterine cavity Allows for directed biopsy at time of procedure	More expensive than transvaginal ultrasonography²¹ Does not evaluate the myometrium or ovaries	94 percent sensitive and 89 percent specific for detecting intracavitary abnormality (data pooled from pre- and postmenopausal women)³⁰
Saline infusion sonohysterography	Has utility of transvaginal ultrasonography with improved capacity to diagnose endometrial abnormalities^21,22	More expensive than transvaginal ultrasonography Limited availability compared with transvaginal ultrasonography	88 to 99 percent sensitive and 72 to 95 percent specific for detecting intracavitary abnormality in premenopausal women^21,22
Transvaginal ultrasonography	Detects uterine tumors, polyps, endometrial and myometrial abnormalities Assesses ovaries	Less sensitive and specific than saline infusion sonohysterography	60 to 92 percent sensitive and 62 to 93 percent specific for diagnosing intracavitary abnormality in premenopausal women^21,22