Hysteroscopy in Asymptomatic Postmenopausal Women With Thickened Endometrium: Analyzing Clinical Characteristics and Pathology With an Emphasis on SERM History.

OBJECTIVE

To optimize cut-off values of endometrial thickness for referral to hysteroscopy among asymptomatic postmenopausal women with thickened endometrium.

DESIGN

A retrospective observational analysis.

SETTING

A teaching hospital.

PATIENTS: 415 asymptomatic postmenopausal cases who underwent hysteroscopy with thickened endometrium between January 2014 to January 2023.

INTERVENTIONS: Patients with endometrium thicker than 5mm underwent hysteroscopy for endometrial pathological examination.

MEASUREMENTS: Transvaginal sonography (TVS) reports of 37732 patients who had ET ≥ 5mm were reviewed. Among them, 415 patients were postmenopausal and asymptomatic. Their clinical characteristics were analyzed retrospectively, including demographic data, TVS reports, hysteroscopy surgery records, and pathology results.

RESULTS

Endometrial thickness significantly differed between patients whose samples were pathologically benign and those who turned out premalignant or malignant (χ2 = 70.7, P < .001). The observed endometrial morphology during hysteroscopy varied notably between these groups (χ2 = 33.3, p < .001). Logistic regression revealed significant associations between treatment by Selective Estrogen Receptor Modulator (SERM; OR = 3.2, p = .04), increased endometrial thickness (OR = 3.7, p < .001), and abnormal endometrial morphology (OR = 3.4, p < .001) with non-benign outcomes. To differentiate for non-benign pathology, the optimal endometrial thickness cut-offs were 10.5mm for all asymptomatic patients with thickened endometrium, 10.5mm for those with concurrent intrauterine lesions, and 19.5mm for those with a history of SERM treatment.

CONCLUSIONS

Increasing the endometrial thickness cut-off value in asymptomatic postmenopausal women, especially for those with a history of SERM treatment, would improve patient management.