Question: Are there guidelines for the management of a postmenopausal patient who has the incidental finding of thickened endometrium on ultrasound (ie a patient without complaint of bleeding or discharge)?
This clinical query answer was produced by RCOG Library staff following the clinical query protocol as described here.
Please note: the search for this response was carried out over 1 year ago. Eligible users may request an update of the evidence by submitting a new Clinical Query here.
Two guidelines addressing this issue were identified:
Map of Medicine pathway for endometrial cancer. 2011
Investigation in asymptomatic postmenopausal women who are not receiving hormone therapy:
"If endometrial thickness is between 5mm and 11mm, further investigation should be based on clinical opinion regarding risk of underlying pathology
if endometrial thickness is above 11mm, consider further investigation with hysteroscopy/biopsy "
Society of Obstetricians and Gynaecologists of Canada. Asymptomatic Endometrial Thickening. 2010.
1. Transvaginal ultrasound should not be used as screening for endometrial cancer.
2. Endometrial sampling in a postmenopausal woman without bleeding should not be routinely performed.
3. Indications for tissue sampling of the endometrium in bleeding postmenopausal women with an endometrial thickness of greater than 4 to 5 mm should not be extrapolated to asymptomatic women.
4. A woman who has endometrial thickening and other positive findings on ultrasound, such as increased vascularity, inhomogeneity of endometrium, particulate fluid, or thickened endometrium over 11 mm, should be referred to a gynaecologist for further investigations.
5. Decisions about further investigations should be made on a case-by-case basis in asymptomatic women with increased endometrial thickening and risk factors for endometrial cancer such as obesity, hypertension, and late menopause.
6. In asymptomatic women on tamoxifen, a routine ultrasound for endometrial thickening should not be performed.
7. Not all postmenopausal women who have asymptomatic endometrial polyps require surgery. Women found to have asymptomatic polyps on ultrasound should be triaged for intervention according to size of the polyp, age, and other risk factors.
(Evidence level IV)
- Map of Medicine. Endometrial Cancer. 2011.
- Society of Obstetricians and Gynaecologists of Canada. Asymptomatic Endometrial Thickening. Clinical Practice Guideline 249. J Obstet Gynaecol Can 2010;32(10):990–999
Search date: June 2012
Classification of evidence levels
Ia Evidence obtained from meta-analysis of randomised controlled trials.
Ib Evidence obtained from at least one randomised controlled trial.
IIa Evidence obtained from at least one well-designed controlled study without randomisation.
IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.
III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.
IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.
The RCOG will not be liable for any special or consequential damages arising from the use or reliance on information contained within the Query Bank.