Hysteroscopic assessment of postmenopausal endometrial thickening

Pathological pattern of endometrial abnormalities in postmenopausal women with bleeding or thickened endometrium

BACKGROUND

Postmenopausal bleeding and an endometrial thickness ≥ 5 mm on sonograms of menopausal women can indicate the presence of endometrial lesions. Diagnostic hysteroscopy is a powerful method for endometrial diseases.

AIM

To investigate the pathological pattern of endometrial abnormalities in postmenopausal women with bleeding or asymptomatic thickened endometrium diagnosed by hysteroscopy.

METHODS

A total of 187 postmenopausal women with bleeding or asymptomatic thickened endometrium underwent diagnostic hysteroscopy. The women were subsequently divided into three groups: Postmenopausal bleeding (PMB) group (n = 84), asymptomatic group (n = 94), and additional group (n = 9). Women in the additional group manifested abdominal pain and leukorrhagia.

RESULTS

Among the 187 patients examined, 84 (44.9%) were diagnosed with PMB and 94 (50.3%) with asymptomatic thickened endometrium. Endometrial polyp was the most common endometrial abnormality, which was detected in 51.2%, 76.6% and 77.8% of the PMB, asymptomatic, and additional groups, respectively. In the PMB group, 7 (8.3%) women had hyperplasia with atypia and 14 (16.7%) had endometrial adenocarcinoma. Fewer malignant lesions were detected in the asymptomatic group. Endometrial hyperplasia without atypia was found in 8.3% of the PMB group and 7.4% of the asymptomatic group.

CONCLUSION

Endometrial polyp was the most common pathology in the PMB group. Diagnostic hysteroscopy is recommended for women with PMB and asymptomatic thickened endometrium.

The Role of Hysteroscopy in Evaluating Postmenopausal Asymptomatic Women with Thickened Endometrium

Backgrounds and Aims:

This study aims to compare hysteroscopic and histological findings in asymptomatic postmenopausal patients with thickened endometrium.

Materials and Methods:

A retrospective study involving case records of 295 asymptomatic postmenopausal women with a thickened endometrium >5 mm diagnosed at transvaginal ultrasound (TVS). Patients (women) underwent hysteroscopy with biopsy between 2009 and 2015, and they were followed up at National Cancer Institute of Bari and at University Hospital of Pisa. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of hysteroscopy were evaluated.

Results:

Inclusion criteria were TVS, hysteroscopy, and endometrial biopsy. When the hysteroscopic findings were normal, a sensitivity of 100%, specificity of 98.6%, PPV of 95.2%, and NPV of 100% were achieved. For polyps and myomas, we found 100%, 98.7%, 99.5%, and 100%, respectively. In case of endometrial hyperplasia, a sensitivity of 66.7%, a specificity of 100%, a PPV of 100%, and a NPV of 98.1% were achieved. For endometrial cancer hysteroscopy, sensitivity, specificity, PPV, and NPV were 100%, 99.6%, 75%, and 100%, respectively.

Conclusions:

Hysteroscopy allows an accurate diagnosis in benign endometrial pathology and suspect of malignant endometrial pathology in postmenopausal women with thickened endometrium.

Hysteroscopy: A necessary method for detecting uterine pathologies in post-menopausal women with abnormal uterine bleeding or increased endometrial thickness

Objective:

To investigate the histologic and hysteroscopic findings of post-menopausal women with uterine bleeding and asymptomatic women with increased endometrial thickness equal or more than 5 mm.

Materials and Methods:

This cross-sectional study was performed between May 2014 and June 2015 on 110 post-menopausal women aged 40-82 years. The women were divided into two groups: Women with abnormal uterine bleeding (AUB group) and asymptomatic women with increased endometrial thickness (asymptomatic group).

Results:

Among the participants, 67 women had AUB and 43 women were asymptomatic. In the AUB group sensitivity, specificity, and positive and negative predictive values of hysteroscopy for normal findings were 98%, 100%, 100% and 90%, respectively. In the asymptomatic group, the same parameters were 98%, 100%, 100% and 85%, respectively. The sensitivity, specificity, and positive and negative predictive values of hysteroscopy for polyps and myomas were 100%. Also, the sensitivity, specificity, and positive and negative predictive values were 100% in hyperplasia cases found during hysteroscopy in both groups.

Conclusion:

Increased endometrial thickness in postmenopausal women with or without AUB is mostly due to benign lesions such as polyps and submucosal myomas. Hysteroscopy is a safe and reliable method for evaluating and treating these lesions.