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What Evaluation of Postmenopausal Bleeding Is Appropriate?

Ultrasound should not be the only evaluation tool for vaginal bleeding in postmenopausal women.

Endometrial hyperplasia and cancer must be ruled out in postmenopausal women with vaginal bleeding, but whether biopsy or ultrasound is more effective for evaluation is controversial. Researchers conducted a meta-analysis of 9 studies to assess the value of ultrasonographic measurement of endometrial thickness for identifying endometrial cancer in postmenopausal women with vaginal bleeding; the studies included 3483 symptomatic women without endometrial cancer and 330 symptomatic women with endometrial cancer. Histologic examination was performed at the time of ultrasound to document presence or absence of cancer.

Median endometrial thickness was 3.7 times greater in women with endometrial cancer than in women without cancer in the same menopausal and estrogen-use categories at the same center. Median endometrial thickness differed significantly among centers. Using a cutoff thickness that would have resulted in a 50% false-positive rate, 96% of cancers would have been detected. If the cutoff thickness had been increased to yield a 10% false-positive rate, only 63% of cancers would have been detected. On the basis of these observations, the researchers concluded that dilation and curettage should be offered to all postmenopausal women with vaginal bleeding.

Comment: This analysis documents that ultrasound should not be the only evaluation tool for postmenopausal bleeding, particularly in women with normal ultrasound findings who continue to bleed. An editorialist predicts that transvaginal sonography soon will be the first step in the evaluation of women with postmenopausal bleeding.

— Robert W. Rebar, MD

Published in Journal Watch General Medicine April 23, 2002

Citation(s):

Tabor A et al. Endometrial thickness as a test for endometrial cancer in women with postmenopausal vaginal bleeding. Obstet Gynecol 2002 Apr; 99:663-70.

• Medline abstract (Free)

Runowicz CD. Can radiological procedures replace histologic examination in the evaluation of abnormal vaginal bleeding? Obstet Gynecol 2002 Apr; 99:529-30.

• Medline abstract (Free)