Transvaginal ultrasonography (TVS) is preferred as the first modality of imaging, to assess endometrial milieu. This will help to reach at some consensus, when to intervene, so that the diagnosis of endometrial hyperplasia (EH) and endometrial carcinoma (EC) is not delayed or missed. This article will discuss about the cut-off of endometrial thickness (ET) in symptomatic premenopausal and perimenopausal women, postmenopausal women with or without bleeding episode(s), and women under HRT and Tamoxifen. However, there is no consensus as to the cut-off value of endometrial thickness in asymptomatic postmenopausal women.

In post-menopausal women with bleeding, the cut-off of endometrial thickness (ET) that warrants investigation is almost defined. Endometrium contains both oestrogen and progesterone receptors, which bind and respond to the above hormones respectively, irrespective of whether the woman is in reproductive or menopausal phase of her life. In the reproductive years of women’s life, the endometrium is a dynamic target organ, regulated by the hypothalamic- pituitary- ovarian axis leading to its cyclical changes mediated through oestrogen and progesterone. This article will discuss the above issues and reach at some consensus about the cut-off of ET after critical analysis of evidence and experience and will help clinicians in arriving at a proper decision in dealing with such clinically confounding situations. Dilemma also exists about the cut-off of ET in both symptomatic and asymptomatic women on HRT and Tamoxifen. However, the cut-off value of ET in asymptomatic postmenopausal women beyond which intervention is required, is still debated. In post-menopausal women with bleeding, the cut-off of ET that warrants investigation is almost defined. Dilemma does remain as to the thickness of endometrium which requires intervention, mostly in symptomatic pre and perimenopausal women.

Thickened endometrium is always a clinical conundrum. The initial best modality of assessing ET or aberration is high resolution transvaginal ultrasonogram. Abundance of oestrogen leads to endometrial hyperplasia, and paucity causes endometrial atrophy. The endometrial thickness (ET) varies according to the phases of the menstrual cycle.Įndometrium contains both oestrogen and progesterone receptors, which respond to above hormones, irrespective of whether the woman is in reproductive or menopausal phase. It undergoes cyclical change regulated by the fine balance between oestrogen and progesterone. The endometrium is a dynamic target organ in a woman’s reproductive life.

The EC Archives by Al Feldstein