Asymptomatic postmenopausal women with sonographically thickened endometrium. What do we do?
Background: A thickened endometrium in the postmenopausal
patient is a common reason for referral to gynaecology rapid access clinics
under the cancer targets wait. This can often be an incidental finding in the
asymptomatic patient. Investigation of this can be invasive, uncomfortable and
carries significant surgical risk. Aims: This paper aims to summarise all the
recent literature to see if there is any clear consensus on who should be
further investigated in this select group of patients. Methods: Systematic
literature review. Results: The studies varied greatly on the need for further
investigation in asymptomatic women with endometrial thickness greater than 11 mm,
with some deciding on careful case selection for further investigation, and
others investigating every patient. The treatment of asymptomatic patients with
endometrium classified as thickened, yet under 11 mm and no symptoms again
varied in case selection and further investigation. Endometrial polyps were mentioned
in 1 paper, suggesting that asymptomatic polyps need not be removed, which is
contrary to current clinical practice. Conclusion: There is no overall opinion
as to the exact treatment of women with thickened endometrium. Women should be
carefully triaged and all other factors taken into account
before further investigation are instigated.