Endometrial Evaluation in Asymptomatic Postmenopausal Women by Transvaginal Sonography and Color Flow Doppler

We attempted to correlate transvaginal ultrasound endometrial assessment with histologic and hysteroscopic findings in 910 asymptomatic postmenopausal women. The women all had been postmenopausal for at least 1 year, and had no sonographically documented adnexal masses, no hormone therapy, and no history of uterine bleeding. Endometrial thickness of 5 mm and less was considered normal, and no further investigations were performed. All women with endometrial thickness 8 mm or greater were advised to undergo hysteroscopy and endometrial biopsy if necessary. When endometrial thickness was 6 to 7 mm, hysteroscopy was recommended if irregular endometrial echotexture was observed; otherwise another ultrasound examination within 3 to 6 months was suggested. We observed 83 (9.1%) asymptomatic women with endometrial thickness 8 mm or greater and 77 (8.5%) with a thickness of 6 to 7 mm, in whom a total of 89 hysteroscopies were performed. Three endometrial cancers, 8 hyperplasias, 27 endometrial polyps, and 5 submucosal myomas were detected in those with endometrial thickness of 8 mm or greater. Of the 21 women with endometrial thickness 6 to 7 mm who underwent hysteroscopy, 7 had endometrial polyps, 4 hyperplasia, and 3 submucosal myomas. Based on sensitivity and specificity analyses, an endometrial thickness of 8 or 10 mm in asymptomatic postmenopausal women seems to be an effective cut-off to select candidates for more invasive diagnostic procedures.