Postmenopausal bleeding is "cancer until proven otherwise." A thin distinct endometrial echo on transvaginal ultrasound has a risk of malignancy of 1 in 917 and does not require an endometrial biopsy. If the endometrial echo is poorly visualized, then in such women, saline infusion sonohysterography is an appropriate next step. The prevalence of asymptomatic endometrial thickening (mostly due to inactive polyps) is high, approximately 10% to 17% of postmenopausal women. The risk of malignancy in such polyps is low (approximately 0.1%), and in structures that mimic polyps, it is also low (0.3%). The incidence of serious complications from an operative intervention in such postmenopausal women is not insignificant (1.3%-3.6%). Thus, automatic intervention in such women, without any high-risk status, is not warranted.
From the New York University School of Medicine, New York, NY.
Received August 11, 2010; revised and accepted December 9, 2010.
Funding/support: None reported.
Financial disclosure/conflicts of interest: Dr. Goldstein has served on advisory boards for Amgen, Boehringer Ingelheim, Eli Lilly, Novo Nordisk, Merck, and Pfizer; has served as a consultant for Cook ObGyn and Philips Ultrasound; is a member of speaker's bureaus for Amgen, Eli Lilly and Warner Chilcott; and serves as a director for Sonosite, Inc.
Presented at the Premeeting Symposium: "Abnormal Uterine Bleeding: Causality, Diagnosis & Management"; October 6, 2010.
Address correspondence to: Steven R. Goldstein, MD, FACOG, NCMP, CCD, New York University School of Medicine, 530 First Avenue, Suite 10N, New York, NY 10016. E-mail: Steven.firstname.lastname@example.org