Ultrasound and menstrual history in predicting endometrial hyperplasia in polycystic ovary syndrome

OBJECTIVE: To assess the role of endometrial thickness on vaginal ultrasoun d assessment and menstrual history in predicting endometrial hyperplasia in women with polycystic ovary syndrome (PCOS) who presented with infertility due to anovulation. METHODS: This was a prospective study in a university referral-based fertil ity and endocrine clinic. Fifty-six women with PCOS presenting with inferti lity due to anovulation underwent both vaginal ultrasound assessments and e ndometrial biopsies. The main outcome measures were the predictive value of sonographic endometrial thickness (primary objective) and the menstrual hi story with other clinical characteristics (secondary objective) for prolife rative endometrium and endometrial hyperplasia in logistic regression analy sis. Their predictive value was further examined by receiver operating char acteristic curve analysis. RESULTS: Thirty-six PCOS patients (64.3%) had proliferative endometrium and 20 (35.7%) had endometrial hyperplasia. Five of the latter (25%) had cytol ogic atypia. Endometrial thickness less than 7 rum or intermenstrual interv al less than 3 months (corresponding to more than four menstrual periods ye arly) was associated with proliferative endometrium only. The endometrial t hickness correlated positively with endometrial hyperplasia (P = .018) and, together with the average intermenstrual interval, were significant predic tors of endometrial hyperplasia (P < .001). CONCLUSION: These findings point to the usefulness of obtaining a detailed menstrual history in women with PCOS by identifying those at increased risk of endometrial hyperplasia and who require an endometrial biopsy. The endo metrial thickness corroborates this clinical impression and is particularly useful when the menstrual history is uncertain. Endometrial hyperplasia in this population is effectively excluded when the endometrial thickness is less than 7 mm. (C) 2001 by the American College of Obstetricians and Gynec ologists.