Thickened Endometrium in Asymptomatic Postmenopausal Women: Is Biopsy Mandatory?

Objectives: To evaluate the value of endometrial sampling and histopathology for asymptomatic postmenopausal women with endometrial thickness !5mm.Population: Two hundred sixty one asymptomatic postmenopausal women with thick endometrium !5mm accidentally discovered during investigations for reasons other than vaginal bleeding. Method: Cases with confirmed thick endomertrium !5mm by TVS underwent outpatient endometrial sampling by chairman curette and sent for histopathology.Results: The TVS findings (endometrial thickening of 5mm or more) were associated with normal endometrium in 237 (90.8%) cases. Abnormal endometrial pathology was detected in 24 (9.1%) cases, it was; simple hyperplasia in 19 (7.2%) cases and complex hyperplasia in three (1.1%) case, endometrial cancer in two (0.7%) cases. Validity tests to predict abnormal endometrium at different cut off values for endometrial thickness shows that cut off values of 5 and 6mm had the highest sensitivity while that of 11 and 12mm had the highest specificity.Conclusion: Although endometrial thickness was significantly higher in asymptomatic postmenopausal women with abnormal endometrial histopathology, there is no cut off value that has accepted both sensitivity and specificity and the need for further evaluation for these cases is not routinely advised.