Transvaginal Ultrasonography of Endometrial Disorders in Postmenopausal Women

Summary: Transvaginal ultrasonography has the potential to become integral to the management of endometrial pathology for women of all ages. In this review we outline the reproducibility of measuring endometrial thickness and examine the data that suggest that a single measurement of endometrial thickness may be used to avoid an invasive biopsy in many symptomatic postmenopausal women. An endometrial thickness of <5.0 mm is highly unlikely to contain significant pathology. The actions of hormone replacement therapy are described, and the effects of tamoxifen on the endometrium and their ultrasound characteristics are also outlined. A thick cystic endometrium in a woman taking tamoxifen has a 50% chance of being a polyp and is associated with hyperplasia and cancer. The use of color Doppler with reference to the detection of endometrial pathology and the impact of hydrosonography for the diagnosis of polyps is discussed. Finally, a number of simple clinical guidelines are suggested.