The objective of this study was to review the management and outcome of asymptomatic
postmenopausal women with increased endometrial thickness as there is lack of robust
guidance for the same.
Retrospective case series over a period of two years
District general hospital
No prospective interventions were done. Only a review of the interventions done in
an outpatient setting, namely hysteroscopy and endometrial sampling, was carried out.
Measurements and Main results
Retrospective review of 1453 referrals to outpatient hysteroscopy service over a period
of two years was carried out and 83 patients referred with asymptomatic thickened
endometrium on imaging were identified. Patients underwent hysteroscopy based on the
local policy, that is, if the endometrial thickness was more than 10mm or in the presence
of additional risk factors. The yield rate of endometrial cancer and atypical hyperplasia
was 1.2 %and 2.4% among all patients (n=83). The yield rate of endometrial cancer
and atypical hyperplasia was 1.81 %and 3.63% among patients referred with endometrial
thickness up to 10mm after considering other risk factors.
It is reasonable to use endometrial thickness of 10 mm or above as a cut off threshold
to offer endometrial biopsy or outpatient hysteroscopy for asymptomatic postmenopausal
women. For asymptomatic women with endometrial thickness between 4-10 mm, decisions
about further investigations should be made on a case-by-case basis, taking into account
any risk factors for endometrial pathology. As this study had reasonably good sample
size, it can contribute towards formulation of robust guidance for management of postmenopausal
women with asymptomatic endometrial thickening.