An overview of the main intrauterine pathologies in the postmenopausal period

Abstract

Hysteroscopy is the gold standard for evaluating the uterine cavity, diagnosing intrauterine pathology, and operative intervention for some causes of abnormal uterine bleeding. The American College of Obstetricians and Gynecologists concluded that, when the endometrium measures ≤4 mm with transvaginal ultrasonography, the likelihood that bleeding is secondary to endometrial carcinoma is less than 1% (negative predictive value 99%), and endometrial biopsy is not recommended. Endometrial sampling in this clinical scenario will likely result in insufficient tissue for evaluation and it is reasonable to consider initial management for atrophy. A thickened endometrium on transvaginal ultrasonography (>4 mm in a postmenopausal woman with postmenopausal bleeding) warrants additional evaluation with endometrial sampling. A negative tissue biopsy following ‘blind’ endometrial sampling in women with postmenopausal bleeding is not considered to be an endpoint, and further evaluation of the endometrial cavity with hysteroscopy to exclude focal disease is imperative.

摘要

宫腔镜检查是评估宫腔、诊断宫腔内病变和某些异常子宫出血原因的手术干预的金标准。美国妇产科医师学会的结论是, 当经阴道超声测量子宫内膜为≤4 mm时, 子宫内膜癌继发出血的可能性小于1%（阴性预测值99%）, 不推荐子宫内膜活检。在这种临床情况下, 子宫内膜取样可能会导致用于评估的组织不足, 因此考虑对萎缩进行初步治疗是合理的。经阴道超声检查增厚的子宫内膜（绝经后出血的女性>4 mm）需要额外的子宫内膜取样评估。对于绝经后出血的女性, 在“盲法”取样子宫内膜后进行组织活检阴性不被认为是终点, 进一步用宫腔镜检查宫腔以排除局灶性疾病是必要的。

Keywords:

• Hysteroscopy
• postmenopausal
• abnormal uterine bleeding
• polyp
• endometrial cancer

Acknowledgements

I would fail in my duty if I did not acknowledge Professor Rodney Baber for being instrumental in this treatise seeing the light of day and from whom I have much to learn. I would like to acknowledge Mrs Susan Brown and Mrs Jean Wright who too have been kind and very helpful.

Potential conflict of interest

No potential conflict of interest was reported by the authors.

Source of funding

Nil.