Transvaginal sonographic study of the endometrium in postmenopausal women

ABSTRACT

To study endometrial thickness [ET] and echogenicity by transvaginal ultrasound [TVS] in a group of normal postmenopausal women another group with postmenopausal bleeding [PMB] and to correlate ultrasonic findings with histopathologic diagnosis in the latter group. The study included 100 normal postmenopausal women and 52 women with PMB scheduled for curettage. ET [double layer technique] was measured for both groups with TVS, and for patients with PMB before curettage was performed. The ultrasonographic findings were correlated with age, age at menopause, parity and postmenopausal period for all cases. In addition, it was correlated with weight and body mass index [BMI] of normal cases, and histological diagnosis of cases with bleeding. In normal postmenopausal women, the ET ranged between 1.3 and 4.9 mm; with a mean [ +/- SD] of 3.34 +/- 0.99 mm, and the most determining factors were weight and age. Women older than 60 years had significantly thinner endomteria compared to women younger than 50 years [mean ET was 3.1 VS 4.4 mm respectively, p< 0.05]. Women with PMB had a mean ET of 11.7 mm [range 1.5-48 mm]. However, patients with ET < 5 mm had no evident athologic lesions at histology; while patients with endometrial thinckness > 20 mm had either atypical endometrial hyperplasia or endometrial carcinoma. TVS measurement of et was found to be a valiable method for discriminating normal from pathologic endometrial, as well as being from malignant endometrial with a high degree of precision. TVS is highly recommended for evaluating patients with PMB. It seems possinle that, in expert hands, it may save many women from an unneeded endometrial curettage. ET < 5 mm is assuring necessitating not more adequate not more than adequate follow up with repeated TVS. On the other hand, denometria thicker than 20 mm at TVS justify meticulous histopathological assessment of the endometrium for the high probability of malignancy