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Endometrial Thickening

Asymptomatic Endometrial Thickening in Postmenopausal Women

 

Decisions about further investigations should be made on a case by case basis in asymptomatic women with increased endometrial thickness.

·         Risk factors for endometrial cancer such as family history, obesity, hypertension, Tamoxifen use and late menopause should be considered.

If there is any postmenopausal bleeding (PMB), they should be referred via the 2WW suspected cancer pathway.

If there is no history of PMB And Endometrial thickness is 5-10mm:

Reassure that it is unlikely there is anything sinister (estimated risk of endometrial malignancy <0.02%), ensure no PMB and advise patient to report any PMB urgently.

If the patient is anxious then refer to GOPD (routine appointment not 2WW) for assessment and consideration of endometrial biopsy (pipelle).

 

If there is nohistory of PMB And Endometrial thickness is >10mm:

Refer to gynaecology for urgent hysteroscopy (risk of malignancy 6%). Letter to gynae oncology team.

 

 

 

Incidental Detection of a  thickened endometrium or polyp in asymptomatic postmenopausal women

 

All patients should have transvaginal ultrasound scan if possible.

    

Instead of ref for urgent hysteroscopy- put REFER TO DIRECT ACCESS HYSTEROSCOPY

  • If on direct questioning at the time of the scan there are symptoms of post menopausal bleeding or vaginal discharge (irrespective of endometrial thickness), patients should be referred to fast track PMB clinic (make explicit who it to refer). Clinical review by GP’s is advised to review the history in patients who are asymptomatic and the thickness is less than 10mm to ensure no relevant history.
  • The same criteria are used for patients on HRT and Tamoxifen.
  • The endometrial thickness measured is the total thickness – i.e. polyp plus endometrium (not length of polyp).

References –

Jacobs I et al.  Transvaginal Ultrasound Screening of postmenopausal women has a high sensitivity for endometrial Cancer- findings from 37,038 women in the UKCTOCS cohort 

Smith-Bindman R et al  How thick is too thick.  Us Obs Gynecol 2004; 24: 558-65

Macdonald R US and gynae cancer : current and potential future uses. Ultrasound 2010; 18: 170-175

SOGC Clinical practice guidelines 2010