The Role of Hysteroscopy in Evaluating Postmenopausal Women with Thickened Endometrium

Postmenopausal bleeding (PMB) is a frequent and abnormal presentation of the end of menses (menopause) which is defined as the permanent cessation of menstruation confirmed following 12 consecutive months of amenorrhea. Postmenopause bleeding, although usually caused by genital atrophy, may indicate endometrial cancer and should not be ignored, and should be investigated promptly by ultrasound and biopsy. Management relies upon cause and good collaborative care enhances the result. Objective to investigate the value of hysteroscope in postmenopausal women with thickened endometrium. This study is proretrospective study which was carried out in Basra Maternity and Child Hospital (2022-2025) 67 menopausal women aged (48-75) years with endometrial thickness >5 mm. The population was divided into two group, with the first 35 patient (Group A) being asymptomatic thickened endometrium and the second group being patients with history of uterine bleeding (symptomatic) with increased endometrium thickness (Group B) 32 patients. All were clinically evaluated, transvaginal ultrasound, office hysteroscopy (vaginoscopic method) under paracervical block was performed and then endometrial biopsy was performed. Hysteroscopic assessment revealed normal, atrophic, hyperplastic, polypoid, myomatous or suspicious malignant endometrium and histopathology confirmed the diagnosis for each group. Inthis study there were 35b postmenopausal women with thickened endometrium who were asymptomatic and 32 with bleeding. Endometrial thickness >12 mm was significantly higher in group B, and hysteroscopy revealed the presence of endometrial polyps as the most frequent lesion in both groups, but suspicion of malignancy was significantly higher in the symptomatic women (6.9% vs. 2.8%). In histopathology specimens, polyps and hyperplasia were more frequently observed in Group B and all three of the endometrial carcinomas were found in symptomatic women. Hysteroscopy had a high diagnostic accuracy with sensitivity of 96.9 % for normal endometrium and good performance in the detection of polyps and hyperplasia. There is a strong association between postmenopausal bleeding and endometrial pathology. Hysteroscopy is extremely accurate and polyps, and hyperplasia, are common findings. Histopathology is still required, and for women with asymptomatic thickening who have been incidentally found, risk evaluation is required to prevent unnecessary invasive procedures.