Management of Asymptomatic Postmenopausal Women Referred to Outpatient Hysteroscopy Service with Incidental Finding of Thickened Endometrium - A UK District General Hospital Experience

Study Objective: The objective of this study was to review the management and outcome of asymptomatic postmenopausal women with increased endometrial thickness as there is lack of robust guidance for the same. Design: Retrospective case series over a period of 2 years. Setting: District general hospital. Patients: Eighty-three. Interventions: No prospective interventions were done. Only a review of the interventions done in an outpatient setting, namely, hysteroscopy and endometrial sampling, was carried out. Measurements and Main Results: Retrospective review of 1453 referrals to outpatient hysteroscopy service over a period of 2 years was carried out, and 83 patients referred with asymptomatic thickened endometrium on imaging were identified. Patients underwent hysteroscopy on the basis of the local policy, that is, if the endometrial thickness was more than 10 mm or in the presence of additional risk factors. The yield rate of endometrial cancer and atypical hyperplasia was 1.2% and 2.4%, respectively, among all patients (n = 83). The yield rate of endometrial cancer and atypical hyperplasia was 1.81% and 3.63%, respectively, among patients referred with endometrial thickness = 10 mm after considering other risk factors. Conclusion: It is reasonable to use endometrial thickness of 10 mm or above as a cutoff threshold to offer endometrial biopsy or outpatient hysteroscopy for asymptomatic postmenopausal women. For asymptomatic women with endometrial thickness between 4 and 10 mm, decisions about further investigations should be made on a case-by-case basis, taking into account any risk factors for endometrial pathology. As this study had a reasonably good sample size, it can contribute toward formulation of robust guidance for management of postmenopausal women with asymptomatic endometrial thickening. Copyright (C) 2021. Published by Elsevier Inc. on behalf of AAGL. All rights reserved.