Sonographic findings in postmenopausal women with a prior endometrial ablation: interpretation and management of women with endometrial thickening and bleeding

OBJECTIVE:To understand the meaning of endometrial thickening and bleeding in postmenopausal women who had previously undergone endometrial ablation (EA).DESIGN:Retrospective observational study.DESIGN:Classification: Canadian Task Force III.SETTING:Unit of Obstetrics and Gynaecology, 'Magna Graecia' University-Catanzaro, Italy.PATIENTS:Sixty-three postmenopausal patients who had previously undergone EA.INTERVENTIONS:A retrospective evaluation of clinical charts of postmenopausal women who performed follow-up visit after EA between January 2000 and August 2014.MEASUREMENTS AND MAIN RESULTS:The rates of endometrial thickening (with or without bleeding), endometrial atrophy and the cancer rates were determined. In nine patients (14.3%) postmenopausal bleeding was reported, while the 85.7% of women did not report bleeding. In the 80.9% of women, an endometrial thickening was observed (mean endometrial value was 7.7 mm ±3.0 SD). A significant (P< .05) number of patients with endometrial thickness between 5-10 mm was observed compared to women with an endometrial measurement <5 mm or >10 mm. A significant (P= .001) increase in endometrial thickness was observed between patients with and without bleeding. Overall, hysteroscopy plus endometrial biopsy were scheduled in 24 patients. In all bleeding women a histologic diagnosis of endometrial atrophy was shown. Concerning bleeding-free women, in 14 subjects with endometrial thickening >10 mm a mucosal atrophy was found out. In the only bleeding-free patient in whom an endometrial echogenic fluid collection was detected, a histological diagnosis of endometrioid endometrial cancer was observed. Thus, in patients who performed hysteroscopy the rate of mucosal atrophy was 95.8%, whereas the endometrial cancer rate was 4.2%. Overall, in our global population (menopause with previous EA) the cancer rate was 1.6%.CONCLUSION:The postmenopausal bleeding and/or the sonographic detection of an endometrial thickening in patients with previous EA are not necessarily related to a malignant disease, but the ultrasound visualization of endometrial thickening plus an echogenic endometrial fluid collection in these patients always needs an invasive diagnostic procedure even if any bleeding is reported.