Endometrial Thickening

Asymptomatic Endometrial Thickening in Postmenopausal Women

Decisions about further investigations should be made on a case by case basis in asymptomatic women with increased endometrial thickness.

Consider risk factors for endometrial cancer:

• Family history
• Obesity / Insulin Resistance (eg PCOS, T2DM)
• Nulliparity
• Tamoxifen use
• Late menopause (>55 years)

Postmenopausal bleeding (PMB) should be referred via the 2WW suspected cancer pathway

If there is no history of PMB And Endometrial thickness is 5-10mm:

Reassure that it is unlikely there is anything sinister (estimated risk of endometrial malignancy <0.02%), ensure no PMB and advise patient to report any PMB urgently.

If the patient is anxious then refer to Gynaecology (routine appointment, not 2WW) for assessment and consideration of endometrial biopsy (pipelle).

If there is no history of PMB And Endometrial thickness is >10mm:

Pt needs urgent hysteroscopy (risk of malignancy 6%).There is a tick box for this on the Suspected Gynaecological Cancer 2ww form under ‘The PMB Pathway.’

  

Incidental Detection of a  thickened endometrium or polyp in asymptomatic postmenopausal women

• The same criteria are used for patients on HRT and Tamoxifen.
• The endometrial thickness measured is the total thickness – i.e. polyp plus endometrium (not length of polyp).

 

References:

Smith-Bindman R et al  How thick is too thick.  Us Obs Gynecol 2004; 24: 558-65

RCCOG Green-top guideline No. 67 February 2016 Management of Endometrial Hyperplasia

BGCS Uterine Cancer Guidelines: recommendations for Practice 2019

 

Author: Dr S Burns
 
              Dr M Schick

Contributors: Lisa Verity Consultant Gyaecologist RCHT

Version:1.2

Date: December 2024                   Review date: December 2026