Hysteroscopy in Asymptomatic Postmenopausal Women with Thickened Endometrium: Analyzing Clinical Characteristics and Pathology With an Emphasis on SERM History.

Objective: To optimize cut-off values of endometrial thickness for referral to hysteroscopy among asymptomatic postmenopausal women with thickened endometrium.

Design: A retrospective observational analysis.

Setting: A teaching hospital.

Patients: 415 asymptomatic postmenopausal cases who underwent hysteroscopy with thickened endometrium between January 2014 to January 2023.

Interventions: Patients with endometrium thicker than 5mm underwent hysteroscopy for endometrial pathological examination.

Measurements: Transvaginal sonography (TVS) reports of 37732 patients who had ET ≥ 5mm were reviewed. Among them, 415 patients were postmenopausal and asymptomatic. Their clinical characteristics were analyzed retrospectively, including demographic data, TVS reports, hysteroscopy surgery records, and pathology results.

Results: Endometrial thickness significantly differed between patients whose samples were pathologically benign and those who turned out premalignant or malignant (χ² = 70.7, P < .001). The observed endometrial morphology during hysteroscopy varied notably between these groups (χ² = 33.3, p < .001). Logistic regression revealed significant associations between treatment by Selective Estrogen Receptor Modulator (SERM; OR = 3.2, p = .04), increased endometrial thickness (OR = 3.7, p < .001), and abnormal endometrial morphology (OR = 3.4, p < .001) with non-benign outcomes. To differentiate for non-benign pathology, the optimal endometrial thickness cut-offs were 10.5mm for all asymptomatic patients with thickened endometrium, 10.5mm for those with concurrent intrauterine lesions, and 19.5mm for those with a history of SERM treatment.

Conclusions: Increasing the endometrial thickness cut-off value in asymptomatic postmenopausal women, especially for those with a history of SERM treatment, would improve patient management.