Asymptomatic Postmenopausal Women Research Articles

OC21.03: Natural history of asymptomatic endometrial polyps in postmenopausal women: a 10‐year follow‐up study

Endometrial polyps in asymptomatic postmenopausal women are present in 15–20% of patients. The prevalence of pre- and malignant endometrial lesion on atrophic endometrium in this group has been recently estimated to be 1.6% and 0.2%, respectively (Ferrazzi et al., AJOG 2009). The objective of this 10 year study was to observe the natural history of endometrial polyps on atrophic endometrium (thickness ⩽ 4 mm) in asymptomatic postmenopausal women. 396 asymptomatic postmenopausal women with sonographic diagnosis of endometrial polyp were prospectively recruited. Patients on HRT and/or TMX treatment were excluded. All patients underwent transvaginal sonography (TVS) with color power Doppler (CD) evaluation, and sonohysterography (SHG). Sonographic follow-up at 3, 6, 12 and every 12 months was proposed as an option to standard hysteroscopic polypectomy. Surgery was considered in case of a high blood flow score (color score 3–4 according to IETA definitions), or in case of bleeding and/or volume growth > 50% at follow-up. Demographic, sonographic and surgical data were recorded. Sonographic follow-up was chosen by 292 patients (group A). 32 patients were lost at follow-up. 40 patients underwent surgery because of drop-out, uterine bleeding or increased volume at follow up, or for other gynaecological indications. Two endometrial cancers were diagnosed after uterine bleeding at 16 and 69 months of follow-up, respectively. In group B, surgical removal was performed in 104 patients by hysteroscopic polipectomy. One pre-malignant lesion was found in surgically treated patients (simple hyperplasia with focal atypia confirmed at hysterectomy). This observational study adds evidence to the feasibility of a conservative management of asymptomatic polyps. Monitoring criteria by using TVS, CD and SHG assessment need to be established.

OC21.05: Saline contrast sonohysterography with liquid‐based endometrial cytology in post‐menopausal patients

Objectives: Endometrial polyps in asymptomatic postmenopausal women are present in 15–20% of patients. The prevalence of preand malignant endometrial lesion on atrophic endometrium in this group has been recently estimated to be 1.6% and 0.2%, respectively (Ferrazzi et al., AJOG 2009). The objective of this 10 year study was to observe the natural history of endometrial polyps on atrophic endometrium (thickness ≤4 mm) in asymptomatic postmenopausal women. Methods: 396 asymptomatic postmenopausal women with sonographic diagnosis of endometrial polyp were prospectively recruited. Patients on HRT and/or TMX treatment were excluded. All patients underwent transvaginal sonography (TVS) with color power Doppler (CD) evaluation, and sonohysterography (SHG). Sonographic follow-up at 3, 6, 12 and every 12 months was proposed as an option to standard hysteroscopic polypectomy. Surgery was considered in case of a high blood flow score (color score 3–4 according to IETA definitions), or in case of bleeding and/or volume growth >50% at follow-up. Demographic, sonographic and surgical data were recorded. Results: Sonographic follow-up was chosen by 292 patients (group A). 32 patients were lost at follow-up. 40 patients underwent surgery because of drop-out, uterine bleeding or increased volume at follow up, or for other gynaecological indications. Two endometrial cancers were diagnosed after uterine bleeding at 16 and 69 months of followup, respectively. In group B, surgical removal was performed in 104 patients by hysteroscopic polipectomy. One pre-malignant lesion was found in surgically treated patients (simple hyperplasia with focal atypia confirmed at hysterectomy). Conclusions: This observational study adds evidence to the feasibility of a conservative management of asymptomatic polyps. Monitoring criteria by using TVS, CD and SHG assessment need to be established.

Breast Arterial Calcification Is Associated with Reproductive Factors in Asymptomatic Postmenopausal Women

The etiology of breast arterial calcification (BAC) is not well understood. We examined reproductive history and cardiovascular disease (CVD) risk factor associations with the presence of detectable BAC in asymptomatic postmenopausal women. Reproductive history and CVD risk factors were obtained in 240 asymptomatic postmenopausal women from a community-based research study who had a screening mammogram within 2 years of their participation in the study. The mammograms were reviewed for the presence of detectable BAC. Age-adjusted logistic regression models were fit to assess the association between each risk factor and the presence of BAC. Multiple variable logistic regression models were used to identify the most parsimonious model for the presence of BAC. The prevalence of BAC increased with increased age (p < 0.0001). The most parsimonious logistic regression model for BAC presence included age at time of examination, increased parity (p = 0.01), earlier age at first birth (p = 0.002), weight, and an age-by-weight interaction term (p = 0.004). Older women with a smaller body size had a higher probability of having BAC than women of the same age with a larger body size. The presence or absence of BAC at mammography may provide an assessment of a postmenopausal woman's lifetime estrogen exposure and indicate women who could be at risk for hormonally related conditions.

Distribution of C-reactive protein and its association with subclinical atherosclerosis in asymptomatic postmenopausal Chinese women

Substantial evidence shows that C-reactive protein (CRP) is associated with atherosclerosis. However, data on the association between CRP and subclinical atherosclerosis are lacking in postmenopausal Chinese women. We aimed to describe the distribution of CRP and its association with metabolic syndrome (MS) and subclinical atherosclerosis in postmenopausal Chinese women in Hong Kong. Between 2002 and 2004, we recruited 518 postmenopausal women aged 50 to 64 years. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III criteria. Subclinical atherosclerosis was determined by measuring carotid intima-media thickness (IMT) and plaque (focal wall thickening ≥1.5 mm) using high-resolution B-mode ultrasonography. Median CRP level was 1.00 mg/L. Women with MS had higher median CRP levels than those without MS (1.85 vs 0.80 mg/L, P < .05), and there was a modest trend toward increasing CRP levels with more metabolic components ( P for trend < .05). Adjusted for age, hormonal use, and lifestyle factors, women with CRP levels of 0.5 to less than 1.0 mg/L had significantly higher mean IMT compared with those with CRP levels of less than 0.5 mg/L (0.78 vs 0.74 mm, P < .05). Odds ratio for plaque was 1.92 (95% confidence interval, 1.06-3.50) for women with CRP levels of 1.0 to less than 3.0 mg/L compared with those with CRP levels of less than 0.5 mg/L. Further adjustment for MS eliminated the associations. C-reactive protein did not add prognostic value to MS in the prediction of subclinical atherosclerosis. Compared with women without MS and who had CRP levels of less than 3.0 mg/L, those with CRP of at least 3.0 mg/L alone had similar IMT levels (0.75 vs 0.74 mm) and prevalence of plaque (19.4% vs 20.0%). Similarly, women with MS and who had CRP levels of at least 3.0 mg/L had similar IMT levels (0.81 vs 0.81 mm) and prevalence of plaque (30.1% vs 29.7%) compared with those with MS alone. C-reactive protein was strongly associated with MS and its individual components. However, it is not an independent predictor of subclinical atherosclerosis in postmenopausal Chinese women.

Value of the progesterone test in screening for endometrial pathology in asymptomatic postmenopausal women receiving treatment with tamoxifen

The aim of this study was to determine the value of the progesterone challenge test (PCT) in screening for the endometrial pathology of asymptomatic postmenopausal women receiving tamoxifen (TMX). A prospective and preliminary study was conducted on 89 postmenopausal women who had been receiving adjuvant treatment for breast cancer with TMX (20 mg/d) for at least 2 years and who had not presented with any episode of postmenopausal metrorrhagia. Transvaginal ultrasound (TVUS), PCT, diagnostic hysteroscopy, and sampling of histologic material were performed on all the women. The validity of the PCT was compared with that of TVUS in screening these women for endometrial pathology, using hysteroscopic biopsy as the gold standard for comparisons. The study protocol was completed in 82 (92.13%) women. The PCT was negative in 69.5% and positive in 30.4% of the cases. The sensitivity of the PCT for detecting the absence of pathology (atrophic endometrium) in the women was 100% versus 91.6% for TVUS; the positive predictive value for endometrial pathology was 100% versus 85.7% for TVUS; and the negative predictive value for hyperplasic pathology was 100% versus 98.1% for TVUS. In asymptomatic postmenopausal women receiving TMX, the PCT presents high sensitivity (100% in our series) and high positive predictive value (100%) in the diagnosis of endometrial pathology and a high negative predictive value (100%) for hyperplasic pathology. Its predictive performance is superior even to that of TVUS. Therefore, although this a preliminary study, we consider that the inexpensive PCT could be an efficient method of screening in these women during or before initiation of TMX therapy.

Endometrial Polyps: Symptomatology, Menopausal Status and Malignancy

Aims: To assess the frequency of premalignant and malignant endometrial polyps in symptomatic and asymptomatic women. Methods: Retrospective registration of 1,124 patients who underwent hysteroscopic resection of endometrial polyps. Patient characteristics included age, menopausal status, presence or absence of symptoms, and use of hormonal medication. Histological diagnoses and complications were also analyzed. Results: 641 (57%) of 1,124 women with endometrial polyps were postmenopausal and 483 (43%) premenopausal. Abnormal uterine bleeding was reported by 548 women: 226 (49%) postmenopausal and 322 (51%) premenopausal. 576 (51%) women were asymptomatic. There were 16 patients with malignancy or premalignant conditions among the symptomatic patients (2.7%) compared to 7 such patients among the asymptomatic patients (1.3%; p = 0.17). Pathologic evaluation disclosed 7 cases of malignancy and 4 cases of atypical hyperplasia among bleeding postmenopausal women (11/263, 4%) and 2 malignancies and 3 cases of hyperplasia with atypia among asymptomatic postmenopausal women (5/378, 1.3%). Conclusion: We found premalignancy and malignancy in each patient group – pre- and postmenopausal, as well as symptomatic and asymptomatic. We recommend removal of any verified endometrial polyp.

Hysteroscopy for asymptomatic postmenopausal women with sonographically thickened endometrium

Hysteroscopy for asymptomatic postmenopausal women with sonographically thickened endometrium

Indication and Necessity of Operative Hysteroscopy for Asymptomatic Postmenopausal Women with Endometrial Polyp

Indication and Necessity of Operative Hysteroscopy for Asymptomatic Postmenopausal Women with Endometrial Polyp

O355 Evolution of ultrasonographically detected non-complex adnexal cysts in asymptomatic postmenopausal women

O355 Evolution of ultrasonographically detected non-complex adnexal cysts in asymptomatic postmenopausal women

P481 Side-effects associated to surgical management of non-complex adnexal cysts in asymptomatic postmenopausal women

P481 Side-effects associated to surgical management of non-complex adnexal cysts in asymptomatic postmenopausal women

Neuroactive steroids after estrogen exposure in depressed postmenopausal women treated with sertraline and asymptomatic postmenopausal women

Neuroactive steroids (NAS) allopregnanolone (ALLO), Allotetrahydrodeoxycorticosterone (THDOC) and dehydroepiandrosterone (DHEA) are important in the regulation of mood and behavior. Knowledge about these steroids in postmenopausal depression and the effect of estrogen on NAS is lacking. We elected to determine if there were differences in NAS between postmenopausal depressed women and age matched controls. We also investigated the effect of estradiol on NAS in post menopausal depressed women receiving a selective serotonin reuptake inhibitor (SSRI), and in non-depressed postmenopausal controls. As part of a previously published double blind study on estrogen acceleration of antidepressant action, post menopausal women with major depression receiving sertraline and healthy non depressed controls were randomized to transdermal estrogen patch 0.1 mg or placebo. NAS were measured at baseline and after 10 weeks of treatment. Depressed subjects were treated with sertraline 50 mg/day to 100 mg/day for 9 weeks. At the baseline and after treatment ALLO and DHEA were significantly lower in depressed women compared to controls. Although all depressed subjects experienced a positive clinical response, estrogen administration was not associated with changes in NAS in either the depressed or the asymptomatic postmenopausal women. The lower ALLO and DHEA in postmenopausal depressed women suggests that symptoms of depression may be influenced by the synthesis or fluctuation of these NAS. Estradiol exposure did not alter ALLO, DHEA, or THDOC, implying these NAS are unlikely to play a role in any mood changes in post menopausal women given estrogen therapy.

Re: Prevalence of endometrial polyps and abnormal uterine bleeding in a Danish population aged 20–74 years

Objective To estimate the prevalence of endometrial polyps and to investigate associated abnormal uterine bleeding in a Danish population aged 20–74 years. Methods This was a study of a random selection of women from the Danish Civil Registration System: 1660 women were invited of whom 686 were included (429 pre- and 257 postmenopausal). AUB was assessed by a validated questionnaire. The women underwent transvaginal sonography (TVS) and saline contrast sonohysterography (SCSH). Hysteroscopic resection was performed in cases with suspected focal intrauterine pathology. Full evaluation was performed in 619 women (two failures of TVS and 60 failures of SCSH, in two women SCSH was contraindicated (endometrial cancer), in two women hysteroscopy was contraindicated, and one polyp was lost before histology). World Health Organization histopathological criteria were used for diagnosing true endometrial polyps. Results On final diagnosis there were 48 women with polyps, eight with submucosal myomas, four with other benign findings and one with polypoidal growing endometrial cancer. Complex hyperplasia without atypia was diagnosed in two women with polyps. The prevalence of endometrial polyps was 7.8% (48/619; 95% CI, 5.6–9.9%). The prevalence was influenced significantly by age (P < 0.005); in women below the age of 30 years, the prevalence was 0.9%. Polyps were diagnosed in 5.8% of pre- and 11.8% of postmenopausal women (P < 0.01). Thirty-nine (82%) of the women who had histopathologically verified polyps were asymptomatic. In asymptomatic premenopausal women the prevalence of polyps was 7.6%, while it was 13% in asymptomatic postmenopausal women. AUB, in particular intermenstrual bleeding, was more frequent among women without polyps (38%). By ultrasound examination, submucosal myomas were diagnosed in 4.2% (26/622; 95% CI, 2.6–5.8%) and intramural myomas in 11.1% (76/684; 95% CI, 8.8–13.5%) of women. Polyps were diagnosed in 2% of oral-contraceptive and 25% of hormone-therapy users. Conclusions The overall prevalence of endometrial polyps was 7.8% and the prevalence increased with age. Polyps were rare (0.9%) in women below the age of 30 years. Surprisingly, AUB was less frequent among women with polyps than among those without polyps. Copyright © 2008 ISUOG. Published by John Wiley & Sons, Ltd.

Hysteroscopy for asymptomatic postmenopausal women with sonographically thickened endometrium

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 (>6 mm). 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 (4.5 mm Storz hysteroscope) and fractionated curettage of the uterine cervix and corpus (D & C) in addition to vaginal sonography (5 MHz probe). Results: The mean age of the women was 64.8 (range 57.7–71.9) years. Average endometrial thickness measured by ultrasound was 12 mm ± 6.7 mm. 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.

Ultrasound in screening of endometrial carcinoma in asymptomatic postmenopausal women

The aim of this prospective study was to investigate whether there was a significant difference in ultrasound detection of pathologic states of endometrium between asymptomatic postmenopausal women and postmenopausal women with uterine bleeding in whom the thickness of endometrium was greater than 3 mm at ultrasound examination. The study included 128 postmenopausal women with uterine bleeding and 29 asymptomatic posmenopausal women who underwent gynecological examination, transvaginal ultrasound examination, fractional explorative curettage and histopathological examination of the endometrium. The results showed no statistically significant difference between the examined groups of women in relation to the detection of pathologic states of the endometrium (polyps, hyperplasias and carcinomas) as well as between individual pathologic states, although the research showed that the asymptomatic women were more frequently presented with well-differentiated carcinoma versus the medium-differentiated carcinoma in the symptomatic group of women. It can be concluded that the transvaginal ultrasound examination in postmenopausal women could be an adequate screening method for detection of endometrial carcinoma in early asymptomatic stage of the disease, whereas in the women with ultrasound finding of the thickened endometrium, the final diagnosis should be established by histopathological examination of the endometrium samples obtained by hysteroscopy, instead of previously used explorative curettage.

How often are endometrial polyps malignant in asymptomatic postmenopausal women? A multicenter study

How often are endometrial polyps malignant in asymptomatic postmenopausal women? A multicenter study

Markers of inflammation are strong predictors of subclinical and clinical atherosclerosis in women with hypertension

Cardiovascular diseases in women still rises and remains their leading cause of death in most developed countries; yet we have less sex-specific data in women than in men as a result of lower enrollment in clinical trials and low rates of sex-specific reporting. The aim of our study was to evaluate in hypertensive postmenopausal women the potential predictive role of markers of inflammation, for example, fibrinogen and C-reactive protein (CRP), on subclinical and clinical atherosclerosis, beyond that of the other established cardiovascular risk factors. We studied 127 asymptomatic hypertensive postmenopausal women with different degrees of carotid intima-media thickness, as examined by the eco-color-doppler ultrasonography, evaluating in a 5 years follow-up cerebrovascular and cardiovascular morbidity and mortality. We preliminarily found that both fibrinogen and CRP levels were associated with the extension of carotid atherosclerosis (P<0.0001 and P=0.0445, respectively). We also found that among all established traditional cardiovascular risk factors (including obesity, diabetes, smoking habit, family history of coronary artery disease, dyslipidemia) only older age (P=0.0162), elevated fibrinogen (P=0.0298), and CRP (P=0.0345) were independent predictors of subclinical atherosclerosis. At the end of follow-up patients clinical events were registered in the 24% of patients and multivariate analysis revealed the following predictors of events: elevated CRP levels [odds ratio (OR): 12.6], the presence of family history of coronary artery disease(OR: 8.8) and older age (OR: 1.1). Beyond the utility of CRP and fibrinogen levels in the prediction of subclinical and clinical atherosclerosis, the therapeutic implications of these results remain to be evaluated by further studies.

Ultrasound detection of endometrial fluid in postmenopausal women

The aim, of this prospective study was to estimate whether the presence of endometrial fluid detected by transvaginal ultrasound investigation was a marker for the pathological changes of the endometrium in postmenopausal women. 128 postmenopausal women with uterine bleeding and 29 asymptomatic postmenopausal women underwent transvaginal ultrasound investigation, curettage and histopathological investigation of the curettage specimens. There were significantly more asymptomatic women with endometrial fluid collection was found (41,4%) than those with uterine bleeding (7,8%) (p<0,001). We found 4 cases of carcinoma of the endometrium, 4 with hyperplasia and 1 with polyp of the endometrium in women with uterine bleeding and endometrial fluid collection. In the asymptomatic group of women we found 1 case with polyp and 1 with carcinoma of the endometrium. In the presence of endometrial fluid collection the least thickness of the endometrium measured by transvaginal ultrasound was 12 mm in postmenopausal women with carcinoma of the endometrium, 7 mm in women with hyperplasia and 5 mm with polyp. No pathological changes were found below the above values. The presence of endometrial fluid detected by transvaginal ultrasonography is a good marker for pathological changes of the endometrium in postmenopausal women if the endometrial thickness is greater than 4 mm. If the endometrial thickness is 4 mm or less, the presence of endometrial fluid is not an indication for further invasive investigation of endometrial cavity, but we must eliminate possible presence of ednexal or cervical malignant disease in some patients.

Prevalence of endometrial polyps and abnormal uterine bleeding in a Danish population aged 20–74 years

To estimate the prevalence of endometrial polyps and to investigate associated abnormal uterine bleeding in a Danish population aged 20-74 years. This was a study of a random selection of women from the Danish Civil Registration System: 1660 women were invited of whom 686 were included (429 pre- and 257 postmenopausal). AUB was assessed by a validated questionnaire. The women underwent transvaginal sonography (TVS) and saline contrast sonohysterography (SCSH). Hysteroscopic resection was performed in cases with suspected focal intrauterine pathology. Full evaluation was performed in 619 women (two failures of TVS and 60 failures of SCSH, in two women SCSH was contraindicated (endometrial cancer), in two women hysteroscopy was contraindicated, and one polyp was lost before histology). World Health Organization histopathological criteria were used for diagnosing true endometrial polyps. On final diagnosis there were 48 women with polyps, eight with submucosal myomas, four with other benign findings and one with polypoidal growing endometrial cancer. Complex hyperplasia without atypia was diagnosed in two women with polyps. The prevalence of endometrial polyps was 7.8% (48/619; 95% CI, 5.6-9.9%). The prevalence was influenced significantly by age (P<0.005); in women below the age of 30 years, the prevalence was 0.9%. Polyps were diagnosed in 5.8% of pre- and 11.8% of postmenopausal women (P<0.01). Thirty-nine (82%) of the women who had histopathologically verified polyps were asymptomatic. In asymptomatic premenopausal women the prevalence of polyps was 7.6%, while it was 13% in asymptomatic postmenopausal women. AUB, in particular intermenstrual bleeding, was more frequent among women without polyps (38%). By ultrasound examination, submucosal myomas were diagnosed in 4.2% (26/622; 95% CI, 2.6-5.8%) and intramural myomas in 11.1% (76/684; 95% CI, 8.8-13.5%) of women. Polyps were diagnosed in 2% of oral-contraceptive and 25% of hormone-therapy users. The overall prevalence of endometrial polyps was 7.8% and the prevalence increased with age. Polyps were rare (0.9%) in women below the age of 30 years. Surprisingly, AUB was less frequent among women with polyps than among those without polyps.

How often are endometrial polyps malignant in asymptomatic postmenopausal women? A multicenter study

The objective of the study was to evaluate the prevalence of cancer and premalignant lesions in polyps on atrophic endometrium in asymptomatic postmenopausal women to compare these findings with a similar cohort of patients with abnormal uterine bleeding. One thousand one hundred fifty-two asymptomatic and 770 consecutive postmenopausal women with abnormal uterine bleeding were included in a retrospective multicenter study. Recruited patients underwent hysteroscopic polypectomy based on a sonohysterographic or hysteroscopic diagnosis. The pathologic report was the main outcome measure. One single case of stage 1 grade 1 endometrial carcinoma on a polyp with a mean diameter of 40 mm (0.1%) was observed in asymptomatic women. This prevalence was 10 times lower than in symptomatic patients (P < .0001). The prevalence of atypical hyperplastic polyps was 1.2% in asymptomatic women (2.2% in symptomatic patients; P < .005). At multivariate analysis, polyps' diameter was the only variable significantly associated to an abnormal histology (cancer, polypoid cancer, and atypical hyperplasia) in asymptomatic women (odds ratio for polyps with mean diameter > 18 mm, 6.9; confidence interval, 2.2-21.4). Follow-up and/or treatment of endometrial polyps incidentally diagnosed in asymptomatic postmenopausal patients could be safely restricted to few selected cases based on polyp diameter.

Operative Hysteroscopy for Asymptomatic Postmenopausal Women with Endometrial Polyp

Operative Hysteroscopy for Asymptomatic Postmenopausal Women with Endometrial Polyp