Is a histology obligatory in the diagnostic of an intrauterine fluid collection (serometra) in asymptomatic postmenopausal women?

Introduction: An endometrium carcinoma is the most frequent female genital malignoma. 10 - 20% of all patients with an endometrium carcinoma are sympt om free up to diagnosis. The frequent occurrence of an endometrium carcinom a combined with an intrauterine fluid accumulation (sero- or mucometra) is controversially discussed in literature. Which hysteroscopic und histologic results are found in patients with an ultrasonographically proven serometr a in menopause and how can these results be explained? Which results can ob served? Method: 48 patients with ultrasonographically confirmed serometra without b leeding underwent hysteroscopy and fractional curettage (D & C). The transv aginal ultrasonography was performed during the check-up. The hysteroscopy was performed with a 4,5 mm-hysteroscope made by Storz. The mean age of the patients was 69.7 +/- 8.2 years. Results: The vaginal ultrasonographically measured endometrium thickness ha d a mean value of 6.2 mm +/- 3.8 mm (2 - 15 mm), whereby the thickest endom etrium structure was measured. An endometrial polyp was diagnosed hysterosc opically in 17 cases (35.4%), in 8 cases a endometrium hyperplasia was diag nosed (16.7%) and in 20 cases an atrophy of the endometrium (41.7%). In 3 c ases (6.2%) there was a suspicion of an endometrial carcinoma. The histolog ic results concurred with the hysteroscopic results. When the endometrium t hickness was 3 mm or less an endometrial atrophy was found in all cases. In 75% of these cases a cervical stenosis was shown in the hysteroscopy. Conclusion: If the endometrium thickness is less than 3 mm all cases show a n atrophic and inactive endometrium. The frequency of intrauterine patholog ies increases with endometrium thickness. The assessment of the endometrium thickness should be a criterion for histological necessity, not solely the presence of a serometra in a thin endometrium. With sonographically proved atrophic endometrium we recommend follow-up examinations in 3 months.