Journal
CLIMACTERIC
Volume 14, Issue 1, Pages 117-120Publisher
INFORMA HEALTHCARE
DOI: 10.3109/13697131003660577
Keywords
POSTMENOPAUSAL BLEEDING; ENDOMETRIAL THICKNESS; ENDOMETRIAL PATHOLOGY
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Objective To determine the prevalence of endometrial hyperplasia and endometrial cancer in postmenopausal women with endometrial thickness of 4.1-8 mm on transvaginal ultrasound scan. Design Prospective observational study carried out in the Heart of England NHS Trust Teaching Hospital in the West Midlands, UK, in a population of 58 women with postmenopausal bleeding. Method Prospective analysis of all women referred to the Rapid Access Clinic in the Heart of England Hospital with a history of postmenopausal bleeding over a 12-month period (April 2007-April 2008). Endometrial histology was taken as the final diagnosis. The main outcome measure was endometrial histology in women with postmenopausal bleeding with endometrial thickness of 4.1-8 mm. Results All women (n = 58) diagnosed with endometrial thickness of 4.1-8 mm on transvaginal sonography were included in the analysis. Pipelle endometrial biopsy could only be performed in 22 women (37.9%). Hysteroscopy was performed in 45 women (77.5%). Out of these, a histological diagnosis was available in 28 women (62.2%). In the remaining 17 women, the endometrium was observed as atrophic on hysteroscopy. In these 17 cases, either no or insufficient endometrial sample was obtained. In total, two (3.4%) women were diagnosed with complex endometrial hyperplasia and two (3.4%) women were diagnosed with endometrial carcinoma. Conclusion There was a significant prevalence of endometrial hyperplasia and endometrial cancer in postmenopausal women with a history of postmenopausal bleeding and who had endometrial thickness of 4.1-8 mm. Therefore, the current recommendation of histological assessment on all women with endometrial thickness >4 mm should remain unchanged.
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