Ultrasonographic and histopathological findings depicting endometrial thickness in AUB

The endometrium is a dynamic organ in the female reproductive years, influenced by hormonal changes during each menstrual cycle. The aim of a recent study was to correlate ultrasonographic endometrial thickness with histopathology in women with abnormal uterine bleeding (AUB) and determine a cutoff value for endometrial thickness to guide intervention and ensure no endometrial pathology is missed.

This observational study involved 242 peri-menopausal and postmenopausal women aged 40 and above presenting with AUB.

The receiver operating characteristic (ROC) curve analysis identified a cutoff point of 14.20 mm for endometrial thickness to distinguish between abnormal and normal histology. The area under the curve (AUC) was 0.783, with a 95% CI of 0.686-0.880 (a sensitivity of 71% and a specificity of 90%).

The results suggested that heavy menstrual bleeding and frequent cycles were commonly associated with gynecological pathology in these age groups. For peri- and postmenopausal AUB, transvaginal sonography is the best initial investigative modality to measure the endometrial thickness. An endometrial thickness cutoff of ≥14 mm is crucial. 

Peri-menopausal AUB may pose various presentations––heavy menstrual bleeding and frequent cycles are often linked to gynecological pathology. Transvaginal sonography for endometrial thickness is the preferred initial investigation method. Combining it with color Doppler enhances diagnostic accuracy. Endometrial biopsy for histopathological examination should be offered to all peri-menopausal AUB patients with an endometrial thickness of 13 mm or more. However, with positive Doppler findings, focal abnormalities, coexisting risk factors like obesity, diabetes, age ≥45 years, or postmenopausal bleeding, an endometrial biopsy should be considered regardless of thickness due to the increased risk of significant endometrial pathology.

Source: Mishra P, Panda S R, Panda J, et al. Indian J Obstet Gynecol Res 2024;11(2):185-190