Long-term outcome of postmenopausal women with proliferative endometrium on endometrial sampling

Rotenberg, O.; Doulaveris, Georgios; Fridman, Dmitry; Renz, Malte; Kaplan, Julie; Xie, Xianhong; Goldberg, Gary L.; Dar, P.

doi:10.1016/j.ajog.2020.06.045

Cited by 9 publications

(9 citation statements)

References 22 publications

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“…47 In this study, proliferative endometrium also conferred a 5.5-fold higher risk of developing endometrial hyperplasia and a 3.7-fold higher risk of endometrial cancer. 47 Due to the increased risks of endometrial hyperplasia and cancer, long-term surveillance of postmenopausal women with a diagnosis of proliferative endometrium may therefore be considered.…”

Section: Safety Of Estrogen Preparationssupporting

confidence: 50%

“…Endometrial proliferation in postmenopausal women appears to correlate with increased risk of endometrial hyperplasia and malignancy. A retrospective cohort study found that postmenopausal women with a diagnosis of proliferative endometrium on biopsy were younger and had higher body mass indices than those with atrophic endometrium 47 . In this study, proliferative endometrium also conferred a 5.5-fold higher risk of developing endometrial hyperplasia and a 3.7-fold higher risk of endometrial cancer 47 .…”

Section: Safety Of Estrogen Preparationssupporting

confidence: 45%

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Endometrial safety of low-dose vaginal estrogens

et al. 2023

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It is estimated that up to 50% to 90% of postmenopausal women may experience genitourinary syndrome of menopause (GSM), which may have a detrimental impact on quality of life. One of the most effective modes of treatment of GSM is low-dose vaginal estrogens. Numerous studies have addressed the safety of these estrogens using endometrial biopsy and/or endometrial thickness on ultrasound. Based on these studies, the consensus is that low-dose vaginal estrogens do not substantially increase the risk of endometrial hyperplasia or cancer; however, the data are severely limited by short duration of follow-up. Although long-term trials are warranted, they are difficult to carry out, costly, and will not yield data for years. More immediate information regarding endometrial safety may be obtained from studies measuring endometrial tissue and serum concentrations of estradiol, estrone, and relevant equine estrogens after administration of different estrogen formulations and doses. This would allow us to understand better the metabolism of estrogens by the vagina and endometrium, and how much estrogen is reaching the endometrium. Here, we discuss metabolism, receptor binding, and signaling of estrogens in vaginal and endometrial tissue, and summarize the existing studies on the endometrial impact of low-dose vaginal estrogen treatment in postmenopausal women.

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Section: Safety Of Estrogen Preparationssupporting

confidence: 50%

Section: Safety Of Estrogen Preparationssupporting

confidence: 45%

Endometrial safety of low-dose vaginal estrogens

et al. 2023

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“…One study to date has evaluated long-term outcomes associated with proliferative endometrium. 1 In a cohort of patients aged 55 years or older, 278 patients with proliferative endometrium were compared with 684 patients with atrophic endometrium on biopsy. Both groups underwent surveillance for more than 11 years.…”

Section: Observationmentioning

confidence: 99%

Proliferative Endometrium in Menopause

Abraham

2023

Obstetrics &Amp; Gynecology

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“…In 2009, the American College of Obstetricians and Gynecologists (ACOG) published the recommendation that women with PMB may be assessed initially with either endometrial biopsy or transvaginal sonogram (TVS) with measurement of the endometrial echo (EE). ACOG recommended further workup if the endometrial thickness is >4 mm or if bleeding persists, as thickened EE is associated with an increased risk of endometrial hyperplasia or cancer (3)(4)(5). The gold standard for the diagnosis of endometrial hyperplasia or cancer in women with PMB has been hysteroscopy with endometrial curettage.…”

Section: Introductionmentioning

confidence: 99%

Differences between proximal and distal endometrial monolayer thickness in women aged over 50 years undergoing saline infusion sonohysterography

et al. 2022

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Background Saline infusion sonohysterography (SIS) is a procedure performed to evaluate the endometrium in women with postmenopausal bleeding. Purpose To investigate differences in endometrial monolayer measurements in women aged >50 years undergoing SIS. Material and Methods Retrospective study of women aged >50 undergoing SIS. Endometrial echo (EE) was measured according to the International Endometrial Tumor Analysis (IETA) guidelines. Monolayer thickness was compared between anterior and posterior uterine walls and between the monolayer that was proximal or distal to the ultrasound probe. Presence and location of focal thickening and polyps on each of the monolayers were assessed. Results SIS was performed in 608 patients. Of them, 485 (79.8%) had anteverted, 85 (14%) retroverted, and 38 (6.2%) a midposition uterus. The mean posterior monolayer was thicker than the anterior monolayer (2.14 mm vs. 1.88 mm; P = 0.002). The distal monolayer was thicker than the proximal layer in both anteverted and retroverted uteri (2.18 mm vs. 1.84 mm; P < 0.0001). In 16% of women, the difference between distal and proximal monolayers was ≥1 mm. Focal thickening was seen 3.3 times more frequently in the distal endometrium. Among women with a double layer EE >4 mm, 18.8% had a proximal layer of <2 mm while only 4.6% had a distal EE <2 mm. Conclusion Distal endometrium measures thicker than the proximal endometrium in most SIS cases and in one out of six women, the difference is >1 mm. The distal layer is three times more likely to contain focal thickening. Sonologists should be conscious of possible enhancement artifact when measuring the EE during SIS.

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Long-term outcome of postmenopausal women with proliferative endometrium on endometrial sampling

Cited by 9 publications

References 22 publications

Endometrial safety of low-dose vaginal estrogens

Endometrial safety of low-dose vaginal estrogens

Proliferative Endometrium in Menopause

Differences between proximal and distal endometrial monolayer thickness in women aged over 50 years undergoing saline infusion sonohysterography

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