Endometrial thickness for invasive investigations in women with postmenopausal bleeding.
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.


METHODS
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.


METHODS
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.


CONCLUSIONS
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.
Raouf
S A
SA
Department of Obstetrics and Gynaecology, Heart of England NHS Foundation Trust, Birmingham, UK.
Gupta
P
P
Papaioannou
S
S
Pradhan
P
P
D000230:Adenocarcinoma / Q000175:diagnosis; D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy; D001706:Biopsy; D004714:Endometrial Hyperplasia / Q000175:diagnosis; D016889:Endometrial Neoplasms / Q000175:diagnosis; D004717:Endometrium / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D008875:Middle Aged; D011127:Polyps / Q000175:diagnosis; D011446:Prospective Studies; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000209:etiology*