[Transvaginal ultrasound of the endometrium in postmenopause]

We checked on the validation of vaginal ultrasound parameters to detect endometrial neoplasma by apposing the histological and sonographical data of 232 patients with postmenopausal bleeding. An endometrial height of more than 4 mm proved a good preliminary fact to screen for pathological findings (sensitivity: 94.9% for endometrial cancer and 84% for benign and malignant neoplastic lesions). The low specificity (53%) of this threshold value can be increased by including morphological parameters like inhomogeneous structure, irregular demarcation and lack of an endometrial middle echo. When screening postmenopausal women by transvaginal sonography these must be taken into account particularly with younger patients whose menopause occurred only recently. Until the age of sixty, respectively until 5 years after menopause, 50 to 70% endometrial proliferation must be taken into account causing an endometrial height of more than 4 mm in ultrasound. Therefore, before starting invasive diagnostics, one should confirm the postmenopausal state of asymptomatic patients without additional sonographical criteria and exclude other reasons for endometrial proliferation.