BMJ  2007;334:635-636 (24 March), doi:10.1136/bmj.39126.628924.BE

Practice

Rational imaging

Imaging the endometrium in postmenopausal bleeding

A Sahdev, consultant radiologist

Department of Radiology, St Bartholomew's Hospital, London EC1A 7BE

Correspondence to: anju.Sahdev@bartsandthelondon.nhs.uk

The first 150 words of the full text of this article appear below.

The patient

A 72 year old multiparous woman presented with intermittent postmenopausal bleeding. The patient's relevant medical history included insulin dependent diabetes, hypertension, and recent breast cancer. She had been treated with tamoxifen for three years. On examination, the patient was obese (body mass index 32) and no cause for the bleeding was found in the introitus, vulva, vagina, cervix, uterus, or adnexa. She was referred to the cancer unit for gynaecological assessment in accordance with "improving outcomes in gynaecological cancers" 1999 guidelines.1


Risk factors for endometrial cancer are prolonged (more than five years) use of unopposed oestrogen hormone replacement therapy, tamoxifen use, hereditary non-polyposis colorectal carcinoma, obesity combined with diabetes, hypertension, and endogenous or exogenous increase in oestrogens
Transvaginal ultrasound should be the primary imaging investigation for assessing the endometrium in postmenopausal women with vaginal bleeding
Endometrial thickness of 5 mm or more requires endometrial biopsy; thickness less than 5 mm . . . [Full text of this article]


What imaging tests do I request?

Outcome


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Rapid Responses:

Read all Rapid Responses

Don't be ridiculous
James Currie
bmj.com, 23 Mar 2007 [Full text]
Authors Response
A Sahdev
bmj.com, 26 Mar 2007 [Full text]
The endometrial thickness on TVS
Suresh Pai
bmj.com, 26 Mar 2007 [Full text]
Imaging the endometrium in postmenopausal bleeding
Patrick Neven, et al.
bmj.com, 14 May 2007 [Full text]
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