TRANSVAGINAL ULTRASONOGRAPHY OF THE ENDOMETRIUM IN WOMEN WITH POSTMENOPAUSAL BLEEDING - A NORDIC MULTICENTER STUDY

OBJECTIVE: The purpose of this study was to use transvaginal ultrasono graphic measurements to find the thickness of the endometrium below wh ich the risk of endometrial abnormality in women with postmenopausal b leeding is low. STUDY DESIGN: This multicenter study was carried out a t eight clinics in four Nordic countries. The study included 1168 wome n with postmenopausal bleeding scheduled for curettage, Before the cur ettage was performed, the thickness of the endometrium was measured wi th transvaginal ultrasonography. The measurement included both endomet rial layers (double-layer technique). The transvaginal ultrasonographi c measurement was compared with the histopathologic diagnosis of the c urettage specimens. RESULTS: In women with atrophic endometrium the me an endometrial thickness (+/-SD) was 3.9 +/- 2.5 mm. The corresponding figures for women with endometrial cancer were 21.1 +/- 11.8 mm. No m alignant endometrium was thinner than 5 mm. In 30 women (2.8%) ii was not possible to measure the thickness of the endometrium; one of these women had endometrial cancer. The 95% confidence limit for the probab ility of excluding endometrial abnormality was 5.5% when the endometri al thickness was less than or equal to 4 mm as measured by transvagina l ultrasonography. CONCLUSION: The risk of finding pathologic endometr ium at curettage when the endometrium is less than or equal to 4 mm as measured by transvaginal ultrasonography is 5.5%. Thus in women with postmenopausal bleeding and an endometrium less than or equal to 4 mm it would seem justified to refrain from curettage.