The thin red line - postmenopausal abnormal uterine bleeding with endometrial thickness less than 4 mm

To evaluate the risk of endometrial malignancy in postmenopausal women with abnormal uterine bleeding (AUB) with endometrial thickness ≤ 4 mm.

Histological assessment of endometrial samples obtained via hysteroscopy or curettage was performed in 57 women.

Women with premalignancy or malignancy (24.6%) had higher endometrial thickness (by 9.7%, p = 0.01) compared to women with benign condition. Out of 12 women with atypical hyperplasia (21.1%), 5 women (8.8%) were diagnosed with simple and 7 women (12.3%) had complex hyperplasia, whereas 2 (3.5%) were diagnosed with malignancy.

Postmenopausal women with AUB and endometrial echo ≤ 4 mm are less likely to have a malignant condition. However, the role of histological evaluation cannot be undermined, especially in women at high risk of endometrial cancer, and routine endometrial biopsy should be considered. We recommend a change in the cut-off to 2 mm in routine practice.