Ultrasound Measurement Of Endometrial Thickness Research Articles

Uterine artery Doppler and endometrial blood flow in frozen embryo transfer: A cohort study.

The implantation rate after assisted reproductive technology depends on 2 important factors, good quality embryo and endometrial receptivity. Endometrial receptivity is mainly assessed by ultrasound measurement of endometrial thickness and morphology. This study aimed to investigate the relationship between uterine artery Doppler indices/endometrial perfusion and pregnancy rate. This cohort study was done on 250 women who were candidates for frozen embryo transfer from January to July 2022. For assessing endometrial receptivity, we performed a Doppler ultrasound of the uterus before embryo transfer with apparently desirable endometrium (endometrial thickness 7 mm and 3 line endometrial pattern). In addition, the women were divided into 2 groups according to assisted reproductive technology outcome (clinical pregnancy), group I positive clinical pregnancy, and group II negative clinical pregnancy, and uterine artery indices and endometrial perfusion were compared between these groups. Uterine artery Doppler showed that the pulsatility index was significantly different between positive and negative clinical pregnancy groups, but resistance index and peak systolic velocity (PSV) did not have statistically significant differences. Also, endometrial perfusion was significantly different between the 2 groups of clinical pregnancy. Endometrial perfusion was significantly better in positive clinical pregnancy groups. Doppler ultrasound can help to assess endometrial receptivity.

Endometrial compaction does not predict live birth in single euploid frozen embryo transfers: a prospective study.

Is there a relationship between endometrial compaction and live birth in euploid frozen embryo transfer (FET) cycles? Live birth rates (LBRs) were similar in both patients that demonstrated endometrial compaction or no compaction in single euploid FETs. There has been increasing interest in the correlation between endometrial compaction and clinical outcomes but there has been conflicting evidence from prior investigations. This was a prospective observational study from 1 September 2020 to 9 April 2021. This study was performed at a single, academically affiliated fertility center in which patients who had an autologous single euploid FET using a programmed or modified natural cycle protocol were included. All embryos had trophectoderm biopsy for preimplantation genetic testing for aneuploidy followed by vitrification at the blastocyst stage. Two ultrasound measurements of endometrial thickness (EMT) were obtained. The first measurement (T1) was measured transvaginally within 1 day of initiation of progesterone or ovulation trigger injection, and a second EMT (T2) was measured transabdominally at the time of embryo transfer (ET). The primary outcome (LBR) was based on the presence and proportion of compaction (percentage difference in EMT between T1 and T2). Of the 186 participants included, 54%, 45%, 35%, 28% and 21% of women exhibited >0%, ≥5%, ≥10%, ≥15% and ≥20% endometrial compaction, respectively. Endometrial compaction was not predictive of live birth at any of the defined cutoffs. A sub-analysis stratified by FET protocol type (n = 89 programmed; n = 97 modified natural) showed similar results. There was the potential for measurement error in the recorded EMTs. The T2 measurement was performed transabdominally, which may cause potential measurement error, as it is generally accepted that transvaginal measurements of EMT are more accurate, though, any bias is expected to be non-differential. The sub-analysis performed looking at FET protocol type was underpowered and should be interpreted with caution. Our study, however, represents a pragmatic approach, as it allowed patients to avoid having to come in for an extra transvaginal ultrasound the day before or on the day of ET. Assessing endometrial compaction may lead to unnecessary cycle cancellation. However, further studies are needed to determine if routine screening for endometrial compaction would improve clinical outcomes. No authors report conflicts of interest or disclosures. There was no study funding. NCT04330066.

Ultrasound Measurement of Endometrial Thickness for Detecting Endometrial Malignancy with Uterine Bleeding in Postmenopausal Women- A Systematic Review

Background: Post-menopausal Bleeding is extremely doubtful of existence a mark intended for incidence of EC as well as around 5% to 12% of post-menopausal bleeding consequences commencing endometrial cancer. EC is greatest communal Gynecologic Malignancy into established countries. Thin endometrium (≤4 mm) devours precise high NPV (99%). Thickened Endometrium has been considered by way of sign intended for an offensive assessment. Aim: To determine the ET measurement for detecting endometrial malignancy with uterine bleeding in post-menopausal females. Methods: The search was led according to Systematic Reviews Ethics. Searched databases were: Google scholar and Web Research from January 2014 and November 2020. Around nine studies were designated for this Systemic Review. We mined subsequent facts: Design of study, mean age and range, menopause duration, range and mean, BMI range and mean, as well as ET range and mean. Conclusion: From beyond examination this review concluded that, the Endometrial Thickness among the suggested alteration in cut off 3-5 mm within repetitive ultrasound practice must be ended in elevation threat females identify for malignancy before in Postmenopausal females as well as ultrasound is attested chosen a convenient implement to diagnose. Keywords: Post-menopausal Bleeding, Endometrial Thickness, Endometrial Cancer.

Ultrasound Measurement of Endometrial Thickness for Detecting Endometrial Malignancy

Background: Post-menopausal Bleeding is extremely doubtful of existence a mark intended for incidence of EC as well as around 5% to 12% of post-menopausal bleeding consequences commencing endometrial cancer. EC is greatest communal Gynecologic Malignancy into established countries. Thin endometrium (≤4 mm) devours precise high NPV (99%). Thickened Endometrium has been considered by way of sign intended for an offensive assessment. Aim: To determine the ET measurement for detecting endometrial malignancy with uterine bleeding in post-menopausal females. Methods: The search was led according to Systematic Reviews Ethics. Searched databases were: Google scholar and Web Research from January 2014 and November 2020. Around nine studies were designated for this Systemic Review. We mined subsequent facts: Design of study, mean age and range, menopause duration, range and mean, BMI range and mean, as well as ET range and mean. Conclusion: From beyond examination this review concluded that, the Endometrial Thickness among the suggested alteration in cut off 3-5 mm within repetitive ultrasound practice must be ended in elevation threat females identify for malignancy before in Postmenopausal females as well as ultrasound is attested chosen a convenient implement to diagnose. Keywords: Post-menopausal Bleeding, Endometrial Thickness, Endometrial Cancer.

Accuracy of preoperative sampling diagnosis for predicting final pathology in patients with endometrial carcinoma: a review.

Endometrial cancer (EC) is the most common gynecologic cancer. The most frequent symptom of this disease is postmenopausal bleeding. Diagnosis of EC must be histologically confirmed, and there are several methods for endometrial sampling to obtain cells or endometrial tissue. The first step in diagnosis should be ultrasound measurement of endometrial thickness, followed by endometrial sampling, which can be performed by office endometrial biopsy, hysteroscopic biopsy, or dilatation and curettage (D&C). The review in this article was carried out to present previously published studies, comprehensively evaluate method performance (i.e., overall accuracy of preoperative sampling in patients with endometrial carcinoma, and overall agreement on grade and histological subtype between preoperative endometrial sampling and final diagnosis), and determine which sampling method is most accurate on the basis of the statistical data in the studies analyzed. From the literature analyzed and examined, it can be concluded that preoperative endometrial sampling is not always the best predictor of final histology in EC and has its limitations. In surgical decisions based only on preoperative sampling, a biopsy should be made with caution, and it is necessary to take other parameters into account. Inadequate grading leads to suboptimal clinical management, mainly in early-stage tumors. This review showed that, although hysteroscopic biopsy was mainly associated with the highest tumor grade agreement, and although D&C showed the highest overall accuracy in detecting endometrial carcinoma, the data do not therefore reliably indicate which method yields the most precise results. The results of this review indicate that further studies on larger samples and with greater statistical power are needed to accurately define the role and type of preoperative sampling methods.

Endometrial compaction (decreased thickness) in response to progesterone results in optimal pregnancy outcome in frozen-thawed embryo transfers

To evaluate whether the change in endometrial thickness between the end of the estrogen phase and the day of embryo transfer has an impact on the pregnancy rate in frozen-thawed embryo transfer (FET) cycles. Retrospective observational cohort study. Single tertiary care medical center. Ultrasound images in 274 FET cycles were reviewed. All patients underwent endometrial preparation with the use of hormonal therapy. Ultrasound measurements of endometrial thickness at the end of the estrogen phase and the day of embryo transfer. The change in endometrial thickness and ongoing pregnancy rate. We calculated the ongoing pregnancy rate in patients whose endometrial thickness decreased (compacted) after starting progesterone by 5%, 10%, 15%, or 20% compared with patients with no change or increased endometrial thickness. The ongoing pregnancy rate was significantly increased at all levels of compaction compared with no compaction. The ongoing pregnancy rate showed a significant increase with each decreasing quartile of change in thickness (increased percentage of compaction) in the progesterone phase compared with the estrogen phase. There is a highly significant inverse correlation between the ongoing pregnancy rate and the change of endometrial thickness between the end of estrogen administration and the day of embryo transfer.

Ultrasonograph versus β-human chorionic gonadotropin titer for verification of termination of missed first trimester miscarriage

Introduction Miscarriage is one of the common complications of pregnancy. Up to 20% of recognized pregnancies will end in miscarriage. However, when women were followed with serial serum human chorionic gonadotropin (hCG) measurements, the actual miscarriage rate was found to be 31%. Many pregnancies are lost spontaneously before a woman recognizes that she is pregnant, and the clinical signs of miscarriage are mistaken for a heavy or late menses. In some countries with low resources, ultrasound may be not available in all medical centers. So, confirmation of complete termination of first trimesteric miscarriage may be not possible, and these cases may present with complications of inadequate treatment. So, we need to study other method for verification of successful management such as β-hCG titter. Objective The aim was to assess the usefulness of testing serum β-hCG titer to confirm the effective medical termination of the first trimester miscarriage. Patients and methods A prospective study was conducted at the Department of Obstetrics and Gynecology at Al Zahraa university Hospital in the period between December 2017 and April 2018. A total of 34 pregnant women with first trimester miscarriage (7–13 weeks from the first day of last menstrual period) were submitted for medical termination of miscarriage, and each case was subjected to ultrasonography 7 days after termination of miscarriage (for measurements of endometrial thickness) and serum β-hCG at 3 and 7 days after termination of miscarriage. Results Endometrial thickness decreased after termination of miscarriage (with cut-off value <15 mm). Moreover, β-hCG decreased after medical termination of miscarriage. In our study, receiver operating characteristics curve was used to define the best cut-off value of β-hCG, which was greater than 34 mIU/ml, with sensitivity of 90%, specificity of 70.8%, positive predictive value of 56.4%, and negative predictive value of 94.4%, with diagnostic accuracy of 83.5%. Conclusion Measuring β-hCG level is an effective alternative to transvaginal ultrasound measurements of endometrial thickness to verify the completion of termination of early miscarriage.

Transvaginal Ultrasound Measurement of Endometrial Thickness as a Biomarker of Oestrogen Level and Its Validity in Diagnosing Endometrial Cancer among Postmenopausal Women with Bleeding

Transvaginal Ultrasound Measurement of Endometrial Thickness as a Biomarker of Oestrogen Level and Its Validity in Diagnosing Endometrial Cancer among Postmenopausal Women with Bleeding

Evaluation of the diagnostic role of transvaginal ultrasound measurements of endometrial thickness to detect endometrial malignancy in asymptomatic postmenopausal women.

To assess the diagnostic accuracy of endometrial thickness measurements of transvaginal ultrasound (TVUS) in asymptomatic postmenopausal women in the detection of endometrial malignancy. A retrospective cohort study in a university hospital was undertaken with 276 consecutive asymptomatic postmenopausal women undergoing dilatation and curettage (D&C) and hysteroscopy for an incidental finding of thickened endometrium (≥4mm) between 2003 and 2012. Different endometrial thickness cutoff values were tested on the basis of a pathologic report with carcinoma conditions (endometrial hyperplasia with atypia and endometrial carcinoma). The mean age of patients was 59.8±9.0years. The mean duration of menopause was 11.2±8.9years. The final pathology diagnoses included 107 (38.8%) patients with polyps, 42 (15.2%) with atrophic endometrium, 39 (14.1%) with estrogen exposure, and 19 (6.9%) with normal endometrium. With regard to carcinoma conditions, nine patients (3.3%) had endometrial hyperplasia with atypia and eight patients (2.9%) had endometrial carcinoma. The area under the ROC curve was 0.52 (95% CI 0.44-0.57), which indicated a poor accuracy of endometrial thickness of TVUS for carcinoma conditions. Routine use of endometrial thickness measurement with TVUS does not seem to be an effective diagnostic tool for endometrial cancer because it has a low diagnostic performance in asymptomatic postmenopausal women. Further prospective studies are required to assess the endometrial thickness measurement with TVUS as a screening method in these women.

Endometrial cancer and ultrasound: why measuring endometrial thickness is sometimes not enough

Endometrial cancer is the commonest cancer of the female genital tract in the developed world. Ultrasound measurement of endometrial thickness is commonly used to triage patients with postmenopausal bleeding for histological sampling. The sensitivity of ultrasound in diagnosing endometrial cancer is high, but it has a small, well-defined false-negative rate. In this report we describe two cases, with histological confirmation, of postmenopausal women without any vaginal bleeding, who were subsequently diagnosed with advanced endometrial cancer. They were found to have a thin, normal endometrium on ultrasound. In both cases, histological examination was suggestive of endometrial cancer originating from foci of adenomyosis. These findings suggest that a proportion of the false-negative diagnoses of endometrial cancer on ultrasound could be caused by the disease being confined to the myometrium rather than as a result of suboptimal performance of ultrasound examination.

Bazedoxifene effects on the reproductive tract in postmenopausal women at risk for osteoporosis

The aim of this study was to examine the endometrial, ovarian, and breast safety of bazedoxifene, a novel selective estrogen-receptor modulator, in postmenopausal women at risk for osteoporosis. Healthy postmenopausal women (N = 1,583; mean age, 57.6 y) with lumbar spine or femoral neck bone mineral density T scores between -1 and -2.5 and/or other clinical risk factors for osteoporosis were enrolled in a 24-month, phase 3, randomized, double-blind, placebo- and active-controlled trial. They received daily treatment with bazedoxifene 10, 20, or 40 mg; placebo; or raloxifene 60 mg. Reproductive safety assessments included periodic transvaginal ultrasound measurements of endometrial thickness, ovarian volume, and presence of ovarian cysts; periodic endometrial biopsies; and adverse event reporting. Bazedoxifene was not associated with a significant change from baseline in mean endometrial thickness at month 24. The percentage of participants with a change from baseline in endometrial thickness or endometrial thickness greater than 5 mm at month 24 was similar among groups. There was no consensus diagnosis of endometrial hyperplasia or malignancy in the bazedoxifene or raloxifene groups; the rates of other histologic findings, including endometrial polyps, were low (<5%) and similar among groups. No significant between-group differences were found in the change from baseline in ovarian volume, number or size of ovarian cysts, or incidence of ovarian cancer. Reports of breast pain (<4%) and breast cancer (<1%) were low and evenly distributed among groups. A favorable endometrial, ovarian, and breast safety profile was found after 2 years of treatment with bazedoxifene in healthy, recently postmenopausal women at risk for osteoporosis.

Endometrial Thickness and Serum β-hCG as Predictors of the Effectiveness of Oral Misoprostol in Early Pregnancy Failure

ObjectiveTo evaluate ultrasonographic measurement of endometrial thickness and serum levels of chorionic gonadotropin (β-hCG) as predictors of failure to abort completely in patients designated for uterine evacuation using oral misoprostol. MethodsWomen attending an obstetric outpatient clinic who complained of residual vaginal bleeding 15 days or more after taking oral misoprostol for medical induction of abortion for early pregnancy failure were evaluated by transvaginal ultrasound scan and assay of serum β-hCG. They subsequently underwent dilatation and curettage under general anaesthesia. According to the results of histopathological examination of uterine contents, the study cohort was divided into women with incomplete abortion (19 cases, 19.6%) and cases with complete abortion (78 cases, 80.4%). The results of the ultrasound scan and the assay of serum β-hCG were correlated with the histopathological results to determine the accuracy of these markers in predicting complete abortion. ResultsBaseline characteristics for both groups were similar. The endometrial thickness in the two groups ranged from 11.2 ± 3.9mm in the complete abortion group to 14.6 ± 6.1mm in the incomplete abortion group, a statistically significant difference (P = 0.003). Serum β-hCG levels were statistically different in the two groups (complete abortion 73.9 ± 23.9 IU/L vs. incomplete abortion 109.4 ± 68.4 IU/L, P < 0.001). Measured endometrial thickness ≥ 12mm predicted incomplete abortion with a sensitivity of 88.5%, a specificity of 73.7%, a positive predictive value (PPV) of 93.2%, and a positive likelihood ratio (LR+ve) of 85.6. A serum β-hCG ≥-100 IU/L predicted incomplete abortion with a sensitivity of 87.2%, a specificity of 78.9%, a PPV of 94.4%, and a LR+ve of 85.6. ConclusionQuantitative assay of serum β-hCG and ultrasound measurement of endometrial thickness are clinically useful measures for predicting late failure of medical abortion, but should be used as supplements to clinical assessments.

Measurement of endometrial volume increase during the first week after embryo transfer by three-dimensional ultrasound to detect pregnancy: a preliminary study

Endometrial volume and thickness were measured in 20 women undergoing in vitro fertilization on the day before the embryo transfer and one week later by three-dimensional ultrasound. The endometrial volume increase was higher in the 8 pregnant women (0.70 cm(3) at least) than in the 12 nonpregnant women (0.21 cm(3) at most).

Rapid endometrial preparation for hysteroscopic surgery with oral desogestrel plus vaginal raloxifene: a prospective, randomized pilot study

To evaluate the effects after 10 days of an original treatment combining oral progestins with vaginal raloxifene to maximize the antiproliferative effect on the endometrium. Prospective, randomized, clinical pilot study. Academic research environment. Ninety women with endometrial polyps. On day 1 of the subsequent menstrual cycle, patients were randomized to receive oral desogestrel (n = 30) for 10 days combined with a tablet of raloxifene (60 mg) per vaginam (group A); oral desogestrel at 60 mg/day (n = 30; group B); or oral danazol at 200 mg, three times a day (n = 30; group C). Ultrasound measurement of endometrial thickness on day 11 of both the pretreatment and treatment cycles, surgeon satisfaction (0 to 10, visual analogue scale), and side effects. At the second evaluation, the mean percentage reduction in endometrial thickness in group A was statistically significantly greater than in the other groups. Surgeon satisfaction in terms of endometrial thinning was also greater with group A. Oral desogestrel plus vaginal raloxifene provides a fast, low-cost, and satisfactory preparation of the endometrium for operative hysteroscopy.

Investigating Postmenopausal Bleeding for Endometrial Cancer: Cost-Effectiveness of Initial Diagnostic Strategies

Reported prevalence rates of endometrial cancer in women with postmenopausal bleeding (PMB) range from 3% to 10%, and endometrial cancer presents with PMB in more than 95% of cases. Today, inpatient cervical dilatation and curettage has been replaced by miniature endometrial biopsy (EB) in an outpatient setting, ultrasound (US) study, and outpatient hysteroscopy. The authors used a decision analytic model, made to reflect currently provided services, to evaluate 12 diagnostic strategies using EB, US, and hysteroscopy. Both 4-mm and 5-mm cutoff points were applied to US measurements of endometrial thickness. Diagnostic probability estimates were derived from systematic quantitative reviews, clinical outcomes from literature reports, and cost estimates from local sources and the National Health Service. The major measure of outcome was the cost per additional life year gained (LYG). When compared with a strategy of doing no initial study for PMB, all 12 diagnostic strategies were associated with improved survival. The least expensive approach used US with a 5-mm cutoff. Initial EB or US with a 4-mm cutoff was comparably cost-effective at their most favorable diagnostic performance levels and when the prevalence of disease was 10% or greater. US with a 5-mm cutoff was an attractive option when no cancer upstaging was assumed. Strategies based on combinations of tests or hysteroscopy were not cost-effective for initial evaluation. Initial testing by EB was potentially more cost-effective than strategies based on US at relatively high disease prevalence rates. At a cancer prevalence rate of 5%, US-based strategies were relatively cost-effective. The investigators conclude that women presenting for the first time with PMB should be evaluated by US or EB. The choice between these measures rests on age and patient preference as well as the prevalence of endometrial cancer and the availability of high-quality US. A threshold of either 4 or 5 mm may be used to denote abnormal endometrial thickness on US examination.

Endometrial and vaginal effects of low-dose estradiol delivered by vaginal ring or vaginal tablet

Aims The major aims of the study were to compare the safety of a continuous low-dose estradiol-releasing vaginal ring (ESTring) to that of a vaginal estradiol tablet (Vagifem®) on the endometrium and the relief of subjective symptoms and signs of urogenital estrogen deficiency. Quality of life and acceptability of treatment delivery were also assessed.Study design A prospective, randomized study in which women were assigned in a 2 : 1 ratio to ESTring and Vagifem and followed for 12 months. The primary endpoint was endometrial safety, based on the results of ultrasound measurement of endometrial thickness and a progestogen challenge test at baseline and week 48. Efficacy was determined by subjective assessment of urogenital estrogen deficiency symptoms at baseline and weeks 3, 12, 24, 36 and 48 and assessment of signs of vaginal epithelial atrophy by the clinician at baseline, 12 and 48 weeks. In addition, pelvic floor strength, vaginal cytological evaluation and pH, bacteruria and patient acceptability were assessed. Quality of life was assessed using a menopause-specific quality-of-life questionnaire and a 2-day bladder diary at baseline and 12 and 48 weeks. The comparability of the two groups was assessed using ANOVA, χ2 or Fisher's exact tests.Results A total of 126 women were randomized to ESTring and 59 to Vagifem. There was no statistical difference between the groups in the alleviation of symptoms and signs of urogenital estrogen deficiency. Maturation indices increased in both groups, from generally atrophic at baseline to proliferative or highly proliferative at 48 weeks. After 48 weeks of treatment, there was no statistically significant difference in endometrial thickness between the two groups. A statistically smaller proportion of bleeding/spotting occurred in the ESTring group (n = 0) compared to the Vagifem users (n = 4). Estradiol and total estrone serum levels increased during treatment in both groups but remained within the normal postmenopausal range. General health status in both groups was unchanged but the urogenital component of health burden was significantly improved in both groups. Bladder diary variables showed no differences between treatment groups.Conclusion Equivalent endometrial safety and efficacy in the relief of the symptoms and signs of urogenital estrogen deficiency were demonstrated for the 12 months' use of a low-dose estradiol-releasing vaginal ring and a vaginal estradiol tablet.

The validity of transvaginal ultrasound measurement of endometrial thickness: a comparison of ultrasound measurement with direct anatomical measurement

To compare transvaginal ultrasound measurements of endometrial thickness with direct anatomical measurements and consider the implications of these findings on clinical practice. Prospective observational study using two modalities blinded to each other's findings. Singleton Hospital, Swansea, a medium-sized District General Hospital. Forty-seven women admitted for hysterectomy. All women underwent transvaginal ultrasound scan to measure the endometrial thickness within 16 hours of surgery. Anatomical measurement of the fresh specimen was carried out immediately after surgery. Agreement between ultrasound and anatomical measurements of the endometrial thickness. No ultrasound measurement was possible in 15% of patients. When both values were obtained, transvaginal ultrasound measurements were > 2 mm different from the ruler measurement in 13/40 (33%) with an obvious tendency of the ultrasound scan to over-estimate the endometrial thickness. The mean difference between the two measurements was -0.8 mm (limits of agreement -7.1 to +5.5 mm). The discrepancy was greater in women with endometrial thickness < or = 5 mm (-1.6 mm, limits of agreement -5.7 to +2.6 mm) compared with that in women with endometrial thickness > 5 mm (-0.2 mm, limits of agreement -7.6 to +7.2 mm). Kappa statistics showed good agreement between the two measurements in discriminating between thin and thick endometrium in 77% (kappa = 0.55). Transvaginal ultrasound misdiagnosed a thick endometrium as thin in 3/40 (8%) and misdiagnosed a thin endometrium as thick in 6/40 (15%). Transvaginal ultrasonography is of limited value as a screening test for abnormal endometrium in patients with postmenopausal bleeding if the only parameter of normality is an endometrial thickness of 5 mm or less.

Transvaginal Ultrasound Measurement of Endometrial Thickness as a Biomarker for Estrogen Exposure

Abstract Objective: In clinical settings, transvaginal ultrasound has been used to evaluate abnormal vaginal bleeding. Because the endometrium responds to estrogens, endometrial thickness may constitute a biomarker of estrogen status in postmenopausal women. This study aimed to validate the transvaginal ultrasonographic measurement of endometrial thickness as an estrogen biomarker in asymptomatic, postmenopausal women by demonstrating an association between endometrial thickness and risk factors known to be associated with estrogen exposure. Method: Endometrial thickness was measured in 1,271 women ages 55 to 74 years who underwent transvaginal ultrasound screening as part of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. A questionnaire, completed before screening, provided risk factor information, including reproductive and hormone use histories. Results: Endometrial thickness measurements ranged from 1 to 32 mm (median 3.0 mm). The frequencies of thicker endometrium (≥3.0 mm), according to body mass index (BMI) quartile, were 55.2%, 66.1%, 69.7%, and 76.7% (P &amp;lt; 0.0001). The frequencies of thicker endometrium were 57.8%, 58.3%, and 82.6% among never users, ex-users, and current users of hormone replacement therapy (HRT), respectively (P &amp;lt; 0.0001). Other factors associated with thicker endometrium included age, marital status, history of uterine fibroids, years since menopause, and history of hypertension. Statistically significant associations were not seen in analyses limited to current HRT users (n = 461). In multiple variable analysis (R2 = 0.08), current HRT use (P &amp;lt; 0.0001) and higher BMI (P &amp;lt; 0.0001) were independently associated with thicker endometrium. Conclusion: In postmenopausal women, factors reflecting exogenous (current HRT use) and endogenous (BMI) estrogen exposure were associated with increased endometrial thickness as measured during screening transvaginal ultrasound. Practical limitations related to screening transvaginal ultrasound include measurement variability, lack of information regarding type or dose of HRT, and problems of differentiating true endometrial thickening from unrecognized endometrial polyps or fluid accumulations. Constrained by these limitations, these results partially validate a transvaginal ultrasound measurement of endometrial thickness as a potential biomarker related to estrogen status.

Outpatient hysteroscopy and ultrasonography in the management of endometrial disease.

This review is to inform the ongoing debate about the choice between ultrasound and hysteroscopy in the management of endometrial disease presenting with abnormal uterine bleeding using information provided from recently published literature. Transvaginal ultrasound measurement of endometrial thickness, using 4 or 5 mm cut-offs to define abnormality, is a good test for excluding endometrial cancer in women with postmenopausal bleeding. In contrast, hysteroscopy is a good test for detecting endometrial cancer, but less effective at excluding serious disease. The accuracy of transvaginal ultrasound in diagnosing intracavity pathology such as submucous fibroids and polyps is improved with saline instillation to levels of accuracy comparable to that of outpatient hysteroscopy. Miniaturization of hysteroscopes and ancillary instrumentation (e.g. development of bipolar intrauterine systems) has facilitated 'see and treat' outpatient hysteroscopy, so that it should no longer be considered simply an outpatient diagnostic modality. Preliminary cost-effectiveness studies have supported the use of ultrasound in the diagnosis of endometrial disease, but further, more comprehensive studies are required comparing ultrasound and outpatient hysteroscopy. Recently published research has provided the clinician with high-quality data regarding the accuracy of ultrasound and hysteroscopy in the diagnosis of endometrial disease. Despite this, controversy remains regarding the relative roles of these uterine imaging modalities. Future research needs to be directed towards providing effectiveness and cost-effectiveness data in order to resolve the ongoing debate and guide best clinical practice.

Assessment of abnormal bleeding in menopausal women: an update.

Peri and postmenopausal bleeding, with or without the use of hormone replacement therapy, is a common clinical problem. The exclusion of endometrial hyperplasia and carcinoma is the key issue in the evaluation of patients with abnormal uterine bleeding. Transvaginal ultrasound measurement of endometrial thickness has become a routine procedure and an initial investigation in patients with abnormal uterine bleeding. There is debate as to whether a cut-off of 5 or 4 mm endometrial thickness should be employed. If the endometrial thickness is above these values, polyps have been diagnosed or the patient is presenting with recurrent bleeding, endometrial disease has to be excluded by histological assessment. Outpatient aspiration curettage has superseded dilatation and curettage, which was previously considered to be the gold standard for obtaining endometrial tissue, and provides the same sensitivity in detecting endometrial disease. Hysteroscopy allows visualisation of the uterine cavity and the opportunity for targeted biopsy and removal of endometrial polyps.