Hysteroscopic findings in postmenopausal patients with ultrasonographic diagnosis of endometrial thickening

Objective: To evaluate the results of hysteroscopy for investigating the uterine cavity of postmenopausal women presenting endometrial thickening on ultrasound. Methods: A cross-sectional study was conducted on hysteroscopic evaluations of 329 postmenopausal women presenting with endometrial thickening on transvaginal ultrasonography. Hysteroscopies were performed in an outpatient setting, using a 4 mm optic Hamou II microhysteroscope and gas (CO2) to distend the uterine cavity. A guided biopsy for histology was performed in all patients with suspected endometrial malignancies and in most patients with benign abnormalities. Rresults: Endometrial thickness ranged from 6 to 38 mm (mean of 10.03 ± 4.49 mm). The hysteroscopic findings were polyps in 183 patients (55.62%); atrophic endometrium in 55 patients (16.72%); synechia in 26 patients (7.90%); a “cerebroid” appearance lesion in 13 patients (3.95%); myoma in 12 patients (3.65%); endometrial hyperplasia in 11 patients (3.34%); focal thickening in ten patients (3.04%); proliferative endometrium in eight patients (2.43%); mucus in seven patients (2.13%); and cystic atrophy in four patients (1.22%). Endometrial carcinoma was confirmed by histology in 11 of 13 suspected cases, in which hysteroscopy showed the cerebroid appearance. Hyperplasias were confirmed in seven of 11 cases. The respective accuracy was 99.26 and 96.67%. Nine out of 11 endometrial cancer cases and six out of 12 hyperplasia cases presented uterine bleeding. Cconclusions: The most frequent findings were benign lesions (92.71%). Hysteroscopy with biopsy is an accurate method to detect intracavitary uterine disease.