Journal of Gynecology and Obstetrics

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Management of Proliferative Endometrium on Biopsy in Post-Menopausal Women

Received: 04 September 2016    Accepted: 21 September 2016    Published: 15 October 2016
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Abstract

Post-menopausal bleeding (PMB) is usually caused by several endometrial conditions (hyperplasia and carcinoma) for which there are evidence-based treatments. However, there is little literature and no evidence-based treatments for a finding of proliferative endometrium without atypia on Pipelle endometrial biopsy in women presenting with PMB. Our aim is to explore management and treatment options for this subset of women. This is a retrospective, observational case series review of women presenting with PMB to a gynaecology rapid access clinic at a District General Hospital in Manchester, UK over a period of three weeks. Four women who were found to have a proliferative or secretory endometrium on endometrial Pipelle biopsy were chosen. Their history, examination findings, investigations, treatment and follow-up findings were then analysed. This case series has identified the management dilemma posed by patients with proliferative endometrium with no atypia on endometrial sampling. The four patients were followed-up with a repeat Pipelle endometrial biopsy six weeks after presentation to the specialist gynaecology unit. They were subsequently counselled or treated with oral progesterone therapy for six to eight weeks. The management options included the Mirena intrauterine system (IUS), oral progesterone therapy and discharging the patient back to primary care. There is no consensus on the importance of oral progesterone or the duration of follow up necessary to monitor for the development of endometrial hyperplasia or cancer in this subset of patients. Further research is needed to develop evidence-based, management guidelines for proliferative endometrium in women with PMB.

DOI 10.11648/j.jgo.20160406.12
Published in Journal of Gynecology and Obstetrics (Volume 4, Issue 6, November 2016)
Page(s) 38-43
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Post-Menopausal Bleeding, Proliferative Endometrium Without Atypia, Progesterone Therapy

References
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[2] McBride. The normal post-menopausal endometrium. J Obstet Gynaecol Br Emp 1954;61 (5):691-7.
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[5] Goldstein RB, Bree RL, Benson CB, Benacerraf BR, Bloss JD, Carlos R, et al. Evaluation of the woman with postmenopausal bleeding: Society of Radiologists in Ultrasound-Sponsored Consensus Conference statement. J Ultrasound Med 2001; 20 (10): 1025-36.
[6] SIGN. Investigation of Post-Menopausal Bleeding. 2002.
[7] Paley PJ. Screening for the major malignancies affecting women: Current guidelines. American journal of obstetrics and gynecology 2001; 184 (5): 1021.
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[10] Davidson KG, Dubinsky TJ. Ultrasonographic evaluation of the endometrium in postmenopausal vaginal bleeding. Radiol Clin North Am 2003;41 (4):769-80.
[11] Gupta JK, Chien PFW, Voit D, Clark TJ, Khan KS. Ultrasonographic endometrial thickness for diagnosing endometrial pathology in women with postmenopausal bleeding: a meta-analysis. Acta Obstetricia et Gynecologica Scandinavica 2002; 81 (9): 799.
[12] Dijkhuizen FPHLJ, BrÖLmann HAM, Potters AE, Bongers MY, Heintz APM. The Accuracy of Transvaginal Ultrasonography in the Diagnosis of Endometrial Abnormalities. Obstetrics & Gynecology 1996;87 (3):345-349.
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[17] Van den Bosch T, Vandendael A, Van Schoubroeck D, Wranz PA, Lombard CJ. Combining vaginal ultrasonography and office endometrial sampling in the diagnosis of endometrial disease in postmenopausal women. Obstet Gynecol 1995; 85 (3): 349-52.
[18] Curtis RE, Boice JD, Shriner DA, Hankey BF, Fraumeni JF. Second Cancers After Adjuvant Tamoxifen Therapy for Breast Cancer. Journal of the National Cancer Institute 1996; 88 (12): 832-835.
[19] Karlsson B, Granberg S, Wikland M, Torvid K, Marsal K, et al. Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding — a Nordic multicenter study. American Journal of Obstetrics and Gynecology 1995; 172 (5): 1488.
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Author Information
  • Manchester Medical School, University of Manchester, Manchester, United Kingdom

  • Obstetrics & Gynaecology, The Pennine Acute NHS Hospitals, Crumpsall, United Kingdom

  • Obstetrics & Gynaecology, The Pennine Acute NHS Hospitals, Crumpsall, United Kingdom

Cite This Article
  • APA Style

    Sidharth Srinivas, Sachchidananda Maiti, Perunkulam Jothilakshmi. (2016). Management of Proliferative Endometrium on Biopsy in Post-Menopausal Women. Journal of Gynecology and Obstetrics, 4(6), 38-43. https://doi.org/10.11648/j.jgo.20160406.12

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    ACS Style

    Sidharth Srinivas; Sachchidananda Maiti; Perunkulam Jothilakshmi. Management of Proliferative Endometrium on Biopsy in Post-Menopausal Women. J. Gynecol. Obstet. 2016, 4(6), 38-43. doi: 10.11648/j.jgo.20160406.12

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    AMA Style

    Sidharth Srinivas, Sachchidananda Maiti, Perunkulam Jothilakshmi. Management of Proliferative Endometrium on Biopsy in Post-Menopausal Women. J Gynecol Obstet. 2016;4(6):38-43. doi: 10.11648/j.jgo.20160406.12

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  • @article{10.11648/j.jgo.20160406.12,
      author = {Sidharth Srinivas and Sachchidananda Maiti and Perunkulam Jothilakshmi},
      title = {Management of Proliferative Endometrium on Biopsy in Post-Menopausal Women},
      journal = {Journal of Gynecology and Obstetrics},
      volume = {4},
      number = {6},
      pages = {38-43},
      doi = {10.11648/j.jgo.20160406.12},
      url = {https://doi.org/10.11648/j.jgo.20160406.12},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.jgo.20160406.12},
      abstract = {Post-menopausal bleeding (PMB) is usually caused by several endometrial conditions (hyperplasia and carcinoma) for which there are evidence-based treatments. However, there is little literature and no evidence-based treatments for a finding of proliferative endometrium without atypia on Pipelle endometrial biopsy in women presenting with PMB. Our aim is to explore management and treatment options for this subset of women. This is a retrospective, observational case series review of women presenting with PMB to a gynaecology rapid access clinic at a District General Hospital in Manchester, UK over a period of three weeks. Four women who were found to have a proliferative or secretory endometrium on endometrial Pipelle biopsy were chosen. Their history, examination findings, investigations, treatment and follow-up findings were then analysed. This case series has identified the management dilemma posed by patients with proliferative endometrium with no atypia on endometrial sampling. The four patients were followed-up with a repeat Pipelle endometrial biopsy six weeks after presentation to the specialist gynaecology unit. They were subsequently counselled or treated with oral progesterone therapy for six to eight weeks. The management options included the Mirena intrauterine system (IUS), oral progesterone therapy and discharging the patient back to primary care. There is no consensus on the importance of oral progesterone or the duration of follow up necessary to monitor for the development of endometrial hyperplasia or cancer in this subset of patients. Further research is needed to develop evidence-based, management guidelines for proliferative endometrium in women with PMB.},
     year = {2016}
    }
    

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    T1  - Management of Proliferative Endometrium on Biopsy in Post-Menopausal Women
    AU  - Sidharth Srinivas
    AU  - Sachchidananda Maiti
    AU  - Perunkulam Jothilakshmi
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    JO  - Journal of Gynecology and Obstetrics
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    PB  - Science Publishing Group
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    UR  - https://doi.org/10.11648/j.jgo.20160406.12
    AB  - Post-menopausal bleeding (PMB) is usually caused by several endometrial conditions (hyperplasia and carcinoma) for which there are evidence-based treatments. However, there is little literature and no evidence-based treatments for a finding of proliferative endometrium without atypia on Pipelle endometrial biopsy in women presenting with PMB. Our aim is to explore management and treatment options for this subset of women. This is a retrospective, observational case series review of women presenting with PMB to a gynaecology rapid access clinic at a District General Hospital in Manchester, UK over a period of three weeks. Four women who were found to have a proliferative or secretory endometrium on endometrial Pipelle biopsy were chosen. Their history, examination findings, investigations, treatment and follow-up findings were then analysed. This case series has identified the management dilemma posed by patients with proliferative endometrium with no atypia on endometrial sampling. The four patients were followed-up with a repeat Pipelle endometrial biopsy six weeks after presentation to the specialist gynaecology unit. They were subsequently counselled or treated with oral progesterone therapy for six to eight weeks. The management options included the Mirena intrauterine system (IUS), oral progesterone therapy and discharging the patient back to primary care. There is no consensus on the importance of oral progesterone or the duration of follow up necessary to monitor for the development of endometrial hyperplasia or cancer in this subset of patients. Further research is needed to develop evidence-based, management guidelines for proliferative endometrium in women with PMB.
    VL  - 4
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