At what thickness is the endometrial stripe cause for concern in a woman who has postmenopausal bleeding_ _ obg management signs of early menopause at 35

Since transvaginal ultrasonography (TVS) was introduced in the 1980s, it has been increasingly utilized to evaluate postmenopausal vaginal bleeding. Early menopause symptoms age 45 In August 2009, ACOG reissued a Committee Opinion on the use of TVS in this setting. Does every woman go through menopause 1 Based on the very high negative predictive value of TVS, ACOG recommended a cutoff of 4 mm for endometrial thickness: That is, endometrial stripes 4 mm or thinner require no endometrial sampling; only those thicker than 4 mm require a biopsy.

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Timmermans and coworkers employed an unusual statistical approach in their meta-analysis: Rather than use entire datasets from each study included in their analysis, they attempted to obtain individual patient data. Surgical menopause hrt They identified 74 investigations that reported endometrial thickness and endometrial carcinoma rates in women who experienced postmenopausal bleeding. Thyroid menopause They obtained individual data from 13 of these studies, representing 2,896 women. Perimenopause symptoms age 47 Using a sophisticated receiver operator characteristic (ROC) curve analysis, they calculated summary estimates of the sensitivity and specificity of TVS in diagnosing endometrial cancer in this population. Natural menopause solutions message boards They found the diagnostic accuracy of TVS to be lower than the accuracy demonstrated in the most frequently cited meta-analysis in the literature. Perimenopause age 38 3

TVS accurately predicted the presence of endometrial cancer in women who had postmenopausal bleeding with different rates of sensitivity and specificity, depending on the cutoff used:

Sensitivity and specificity are integrally related; we increase sensitivity at the expense of specificity. What age does menopause start in women Are we willing to increase our detection of true positive test results by also increasing the false-positive rate? The authors suggest that in the setting of a potential cancer diagnosis, clinicians should aim for 100% sensitivity—and they push for a 3-mm cutoff for that reason. Period after menopause normal However, if we shift to a 3-mm cutoff, considerably more women who do not have endometrial cancer will undergo biopsy. Menopause cramps in legs We must also be mindful of the false-negative rate of endometrial sampling and of the fact that not all women can be sampled, because of cervical stenosis or technical difficulties.

The preponderance of data supports the continued use of 4 mm as a cutoff for endometrial sampling: That is, only women who have postmenopausal bleeding and an endometrial stripe thicker than 4 mm need to undergo endometrial biopsy.

It is important to take other variables into account to improve our diagnostic accuracy without increasing the rate of unnecessary endometrial sampling. Menopause heavy bleeding and cramping These variables include consideration of:

One strength of this analysis is that the investigators used the exact endometrial thickness for each patient rather than pooled data. Menopause spotting after 1 year Because of this requirement, however, only 13 of 74 studies of endometrial thickness and the endometrial cancer rate were able to provide data. Menopause female Had all 74 publications provided data, many more patients would have been represented in the meta-analysis. Menopause migraines magnesium Instead, bias was introduced because the small subset of patients whose individual data was available may not represent the entire population. Menopause breasts larger The 95% confidence intervals for sensitivity and specificity reflect the small sample size.

This study also has a number of minor limitations. What is the menopause age range For example, it fails to address the fact that not all TVS studies are optimal studies. Perimenopause symptoms age 46 It can be difficult to measure the endometrial stripe when fibroids are present, when the patient has a history of uterine surgery, or when she is obese. Male menopause hot flashes Uterine position also can affect imaging.

In addition, the technology of TVS has improved significantly over the past two decades, making comparison of older studies (as early as 1995) to more modern studies (as recent as 2008) difficult to justify.

Timmermans and colleagues fail to provide information on the adequacy of TVS in assessing the endometrial stripe. Weight loss in menopause Nor do they provide details on the histologic type of cancer in women who had thin endometrial stripes. Menopause show melbourne The latter data would have been interesting because patients who have rare “type 2” endometrial cancers are more likely to exhibit endometrial stripes thinner than 4 mm. What is the meaning of menopause 4