Office Hysteroscopy After Ultrasonographic Diagnosis of Thickened Endometrium in Postmenopausal Patients

Abstract

The most important sonographic sign of endometrial carcinoma in women with postmenopausal bleeding is a thickened endometrium. The likelihood of endometrial cancer in a patient with an endometrial thickness of 5 mm or less is only about 1%. Office hysteroscopy is widely used to investigate a pelvic ultrasound finding of endometrial thickness in postmenopausal women. The primary purpose of hysteroscopic examination of such women is to exclude endometrial cancer. This retrospective study investigated the results of office hysteroscopy in 245 postmenopausal women with a thickened endometrium detected in a previous ultrasound and assessed the presence or absence of abnormal bleeding on diagnostic outcomes. All office hysteroscopies were performed between 2005 and 2006 at a hospital in Portugal. Hysteroscopic and histopathologic findings were compared in 2 groups of patients: Group A (n = 172) contained patients with asymptomatic thickened endometrium; and group B (n = 73) consisted of symptomatic (bleeding) patients with increased endometrial thickness. The patients were evaluated for parameters of age, hormonal therapy, hysteroscopic findings, duration of the procedure, pain and associated complications, and histopathological diagnosis. The presence or absence of uterine bleeding was considered separately. The mean age of symptomatic patients was higher as compared to asymptomatic patients (67.9 vs. 64.9 years old) (P < 0.05). Symptomatic patients also had significantly longer mean procedure duration (36.1 vs. 31.5 minute) (P < 0.05). In both groups, the most frequent hysteroscopic and histopathological diagnosis was endometrial polyp. Pain was considered tolerable by the majority of patients (median 4 in a numeric 0–10 scale with 10 as the maximum). There were no procedure-related complications. The incidence of carcinoma was significantly higher in symptomatic than asymptomatic women (16.4% vs. 2.9%) (P < 0.05). These findings show that patients with endometrial thickening associated with postmenopausal bleeding are at higher risk for endometrial neoplasia than asymptomatic patients.