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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. 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.