Aakriti Aggarwal1, Archana Hatti2, Sakunthala Sahithi Tirumuru2, Sabita Sivaraman Nair2. 1. Department of Gynaecology, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK. Electronic address: aakritib21@gmail.com. 2. Department of Gynaecology, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK.
Abstract
STUDY OBJECTIVE: The objective of this study was to review the management and outcome of asymptomatic postmenopausal women with increased endometrial thickness as there is lack of robust guidance for the same. DESIGN: Retrospective case series over a period of two years SETTING: District general hospital PATIENTS: 83 INTERVENTIONS: No prospective interventions were done. Only a review of the interventions done in an outpatient setting, namely hysteroscopy and endometrial sampling, was carried out. MEASUREMENTS AND MAIN RESULTS: Retrospective review of 1453 referrals to outpatient hysteroscopy service over a period of two years was carried out and 83 patients referred with asymptomatic thickened endometrium on imaging were identified. Patients underwent hysteroscopy based on the local policy, that is, if the endometrial thickness was more than 10mm or in the presence of additional risk factors. The yield rate of endometrial cancer and atypical hyperplasia was 1.2 %and 2.4% among all patients (n=83). The yield rate of endometrial cancer and atypical hyperplasia was 1.81 %and 3.63% among patients referred with endometrial thickness up to 10mm after considering other risk factors. CONCLUSION: It is reasonable to use endometrial thickness of 10 mm or above as a cut off threshold to offer endometrial biopsy or outpatient hysteroscopy for asymptomatic postmenopausal women. For asymptomatic women with endometrial thickness between 4-10 mm, decisions about further investigations should be made on a case-by-case basis, taking into account any risk factors for endometrial pathology. As this study had reasonably good sample size, it can contribute towards formulation of robust guidance for management of postmenopausal women with asymptomatic endometrial thickening.
STUDY OBJECTIVE: The objective of this study was to review the management and outcome of asymptomatic postmenopausal women with increased endometrial thickness as there is lack of robust guidance for the same. DESIGN: Retrospective case series over a period of two years SETTING: District general hospital PATIENTS: 83 INTERVENTIONS: No prospective interventions were done. Only a review of the interventions done in an outpatient setting, namely hysteroscopy and endometrial sampling, was carried out. MEASUREMENTS AND MAIN RESULTS: Retrospective review of 1453 referrals to outpatient hysteroscopy service over a period of two years was carried out and 83 patients referred with asymptomatic thickened endometrium on imaging were identified. Patients underwent hysteroscopy based on the local policy, that is, if the endometrial thickness was more than 10mm or in the presence of additional risk factors. The yield rate of endometrial cancer and atypical hyperplasia was 1.2 %and 2.4% among all patients (n=83). The yield rate of endometrial cancer and atypical hyperplasia was 1.81 %and 3.63% among patients referred with endometrial thickness up to 10mm after considering other risk factors. CONCLUSION: It is reasonable to use endometrial thickness of 10 mm or above as a cut off threshold to offer endometrial biopsy or outpatient hysteroscopy for asymptomatic postmenopausal women. For asymptomatic women with endometrial thickness between 4-10 mm, decisions about further investigations should be made on a case-by-case basis, taking into account any risk factors for endometrial pathology. As this study had reasonably good sample size, it can contribute towards formulation of robust guidance for management of postmenopausal women with asymptomatic endometrial thickening.