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In pre and perimenopausal women with AUB
Endometrial biopsy is advocated in ovulatory AUB aged = 45 years and in anovulatory AUB < 45 years to rule out endometrial hyperplasia.
It is preferable to advise ultrasonogram in early proliferative phase to detect endometrial abnormalities and avoid false positive result.
Diffuse homogenous thickening of endometrium > 16 mm in secretory phase has been recommended as cut-off.
When premenopausal vaginal bleeding occurs in diabetic obese women with ET > 11 mm, the risk of premalignant/malignant endometrial pathology increases by 25%.
Endometrial biopsy is indicated when ET is > 12 mm in premenopausal women and = 5 mm in perimenopausal women with persistent erratic menstrual bleeding.
Asymptomatic postmenopausal women
Endometrial biopsy should be considered, if the endometrium measures > 11 mm, or with other risk features.
Symptomatic Postmenopausal women
ET > 4 mm endometrial biopsy is required
Persistent or recurrent bleeding, even with endometrial echo complex less than = 4 mm warrants endometrial biopsy to rule out Type II EC.
Women on Tamoxifen
Pretreatment screening with TVS and or endometrial biopsy before Tamoxifen therapy to rule out pre-existing endometrial pathology which may aggravate during treatment with Tamoxifen.
There is no known added risk of endometrial cancer in premenopausal women on Tamoxifen; hence these women need no stringent follow-up.
Though ET of > 8 mm is taken as cut-off in Tamoxifen users, the evidence suggests not to go for endometrial evaluation in asymptomatic women both pre and post-menopausal.
In patients on Tamoxifen presenting with irregular vaginal bleeding endometrial biopsy is recommended.
Woman with PMB should have TVS done and if ET is > 4 mm, endometrial biopsy should be done regardless of any drug use.
Women on HRT
The acceptable range of endometrial thickness is less well established in this group; cut-off values of 8 mm have been suggested in asymptomatic women.
The risk of carcinoma is ~ 7%, if the endometrium is > 11 mm, and 0.002%, if the endometrium is < 11 mm
Women on HRT the ET of > 8 mm should be treated as thickened and endometrial evaluation be done in asymptomatic women.
Women on HRT with PMB endometrial evaluation should be done if ET is > 4 mm
Leone, F.P. et al. Terms, definitions and measurements to describe the sonographic features of the endometrium and intrauterine lesions: a consensus opinion from the International Page 9 of 10 Australasian Society for Ultrasound in Medicine P (61 2) 9438 2078 F (61 2) 9438 3686 E asum@asum.com.au W www.asum.com.au ACN 001 679 161 ABN 64 001 679 161 Endometrial Tumor Analysis (IETA) group. Consensus Statement. Ultrasound Obstet Gynecol 2010; 35:103-112. DOI: 10.1002/uog.7487
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