Ultrasound Assessment of the Menopausal Endometrium
About 1 in 10 women will develop vaginal bleeding after
the menopause (the change of life). The blood loss is usually
slight and often amounts to no more than a little spotting of
underwear. It should always however be investigated.
In the vast majority of patients who develop such bleeding
however, no serious cause is found. Most bleeding episodes
are explained by the hormonal imbalance that occurs around
the time of the change (menopause), by problems related to
hormone replacement therapy (HRT) or by excessive dryness
of the vagina.
In a very small number of patients the bleeding may be due
to cancer of the lining of the uterus (the endometrium). It
is therefore important to assess the endometrium to exclude
cancer.
A transvaginal ultrasound examination of the uterus provides
detailed views of the uterus and endometrium. A thin endometirium
(ie less than 5mm) virtually excludes cancer of the endometrium
(refer figure 1), however should another episode of bleeding
recur after the scan it is still important that you let your
doctor know.
In some patients the endometrium is thickened (>5mm) and
this is usually explained by either problems with HRT or by
overgrowth of the cells lining the cavity (hyperplasia). Hyperplasia
may lead to the formation of a polyp (a grape-like structure
that is attached by a narrow stalk to the endometrium). In
a small number of patients however the appearances of a cancer
may be seen. In these circumstances an endometrial biopsy
(taking a sample of the endometrium) is required.
Menopausal Uterus with a Thin Endometrium
Figure 1 . The lining of the uterus (endometrium) is thin.
This finding is very reassuring and almost excludes all cancers
of the lining of the uterus.
Menopausal Uterus with a Thick Endometrium
Figure 2. The lining of the uterus (endometrium) is thickened.
In most patients such thickening is related to HRT or a benign
process in the endometrium.However in some cases it may indicate
cancer and further investigations such as a curette may be
required.
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