Hysteroscopy for asymptomatic postmenopausal women with sonographically thickened endometrium.

Abstract

UNLABELLED:

Endometrial carcinoma is the most common genital cancer in women. While patients usually present with vaginal bleeding, in 10-20% this characteristic symptom is absent. Endometrial thickness (double layer) is measured by transvaginal sonography and thickening indicates an increased risk of malignancy or other pathology (hyperplasia or polyps).

OBJECTIVE:

We sought to correlate hysteroscopic and pathological findings in asymptomatic postmenopausal women with sonographically thickened endometrium (>6mm).

STUDY DESIGN:

A prospective observational study in a university hospital of 304 postmenopausal women referred between 1996 and 2006 because of a sonographically thickened endometrium in the absence of abnormal bleeding, who underwent continuous flow hysteroscopy (4.5mm Storz hysteroscope) and fractionated curettage of the uterine cervix and corpus (D & C) in addition to vaginal sonography (5MHz probe).

RESULTS:

The mean age of the women was 64.8 (range 57.7-71.9) years. Average endometrial thickness measured by ultrasound was 12mm+/-6.7mm. Hysteroscopy suggested the presence of endometrial polyps in 226 women (74.3%), simple endometrial hyperplasia in 34 (11.2%), atrophic endometrium in 18 (5.9%), complex endometrial hyperplasia in 2 (0.7%), atypical hyperplasia in 3 (1%) and leiomyoma in 9 (3.0%). In 12 women (3.9%), the hysteroscopic appearance suggested malignancy and histology revealed endometrial adenocarcinoma. All hysteroscopic results were confirmed by histological examination.

CONCLUSION:

Hysteroscopy represents an easy, safe and effective method for the investigation of asymptomatic women with a thickened endometrium found with transvaginal ultrasound. The commonest pathology was endometrial polyps.

• Authors: Torsten Schmidt, Martina Breidenbach, Frank Nawroth, Peter Mallmann, Ines M Beyer, Markus C Fleisch, Daniel T Rein
• Journal: Maturitas (Maturitas) Vol. 62 Issue 2 Pg. 176-8 (Feb 20 2009) ISSN: 0378-5122 [Print] Ireland
• PMID: 19121901 (Publication Type: Evaluation Study, Journal Article)

Topics

• Aged
• Atrophy (diagnosis)
• Endometrial Hyperplasia (diagnosis, pathology)
• Endometrial Neoplasms (diagnosis)
• Endometrium (diagnostic imaging, pathology)
• Female
• Humans
• Hysteroscopy (methods)
• Leiomyoma (diagnosis)
• Middle Aged
• Polyps (diagnosis)
• Postmenopause
• Prospective Studies
• Risk Factors
• Ultrasonography
• Uterine Diseases (diagnosis)
• Uterine Neoplasms (diagnosis)