title: Transvaginal ultrasound examination of the endometrium in postmenopausal women without vaginal bleeding.
abstract: OBJECTIVE
  To estimate in gynecologically asymptomatic postmenopausal women with and without hormone replacement therapy (HRT) undergoing transvaginal ultrasound examination the prevalence of: endometrial thickness ≥ 5.0 mm, intrauterine focal lesions if endometrial thickness is ≥ 5.0 mm, and premalignant and malignant endometrial changes if thickness is ≥ 5.0 mm and intrauterine focal lesions are present.
  
  
  METHODS
  Invitation letters were sent to 2951 potentially eligible women recruited from a Swedish population registry; 757 replied, 514 were considered eligible (i.e. were gynecologically asymptomatic postmenopausal women aged 52-62 years with no current or previous gynecological problems) and 510 had complete information and were included. The women were examined using transvaginal ultrasound (5-9-MHz transducer). If endometrial thickness was ≥ 5.0 mm, saline contrast sonohysterography (SCSH) was attempted. The number, size and surface contour of intracavitary focal lesions were recorded. Women with focal lesions were offered hysteroscopic resection of the lesions. Gold standard was histology of the surgical specimen.
  
  
  RESULTS
  The median time in menopause was 5 (range, 1-17) years. There were no substantial differences in ultrasound findings between women with HRT and those without. Sixty-two (12% (95% CI, 9-15%)) women had an endometrial thickness ≥ 5.0 mm. SCSH was attempted in 54 of these women, which was successful in 48 and suboptimal in one. Thirty-three (67%) of the 49 women with successful or suboptimal SCSH and one woman with spontaneous fluid in the uterine cavity had intracavitary focal lesions. Twenty-nine of these women with focal lesions underwent hysteroscopic resection of the lesion(s). Two cases of endometrial complex hyperplasia with atypia but no malignancy were found. Uterine perforation with bowel damage occurred in two women who underwent hysteroscopic surgery.
  
  
  CONCLUSIONS
  About 10% of gynecologically asymptomatic postmenopausal women have a sonographic endometrial thickness ≥ 5.0 mm. Our results support conservative management of such women. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
authors.affiliation: Department of Obstetrics and Gynecology, Skåne University Hospital Malmö, Lund University, Malmö, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Jokubkiene
authors.affiliation: Department of Obstetrics and Gynecology, Skåne University Hospital Malmö, Lund University, Malmö, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Sladkevicius
authors.affiliation: Department of Obstetrics and Gynecology, Skåne University Hospital Malmö, Lund University, Malmö, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Valentin
mesh_terms: D055088:Early Detection of Cancer; D004714:Endometrial Hyperplasia / Q000000981:diagnostic imaging* / Q000473:pathology; D004717:Endometrium / Q000000981:diagnostic imaging* / Q000473:pathology; D019160:Endosonography; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D007889:Leiomyoma / Q000000981:diagnostic imaging* / Q000473:pathology; D008875:Middle Aged; D017698:Postmenopause; D015995:Prevalence; D012680:Sensitivity and Specificity; D013548:Sweden; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D014621:Vagina / Q000000981:diagnostic imaging*
keywords: asymptomatic diseases; endometrial hyperplasia; endometrial neoplasm; endometrium; polyp; postmenopause; ultrasonography