The relationship between endometrial thickening and endometrial lesions in postmenopausal women

Association of endometrial thickness with lesions in postmenopausal asymptomatic women: risk factors and diagnostic thresholds

PURPOSE

This study aimed to explore the relationship between endometrial thickness and lesions in asymptomatic postmenopausal women and identify diagnostic thresholds for lesions.

METHODS

A total of 279 postmenopausal asymptomatic women aged 40 years or older with endometrial thickness ≥ 4 mm were retrospectively selected in our hospital, from January 2018 to June 2023, there were 33 cases's operations which were failed due to the cervical stenosis, 8cases who used hormone replacement therapy within the past year, 7 cases with hysteromyoma that affect the shape of the uterine cavity line, and 5cases's hysteroscopic tissue acquisition were failed. Finally, A retrospective study was conducted on the endometrial thickness of 226 postmenopausal asymptomatic women measured by transvaginal ultrasound and those with thickening were subjected to hysteroscopy and pathological examination of endometrial biopsy tissues, and were divided into a normal group (80 cases), benign lesion group (143 cases), and malignant lesion group (3 cases) according to the pathology results. The endometrial thickness results measured by vaginal ultrasound were compared with the endometrial histopathologic results.

RESULTS

1. There were 226 cases in all, including 117 cases of endometrial polyps (51.7%);2. BMI ≥ 25 kg/m² is a risk factor to postmenopausal asymptomatic women. OR = 1.132 P < 0.05,95%CI (1.039,1.234);3. endometrial thickness ≥ 4 mm is a risk factor to postmenopausal asymptomatic women. OR = 7.927 P < 0.05, 95%CI (3.015,20.839);4. The results of the Receiver Operating Characteristic (ROC) analysis of the subjects show that the optimal cut-off value for screening endometrial pathology by endometrial thickness in asymptomatic postmenopausal women is 5.65 mm, and its area under the curve for identifying endometrial lesion was 0.679.

CONCLUSION

1. The main cause of endometrial thickening after menopause was endometrial polyps (51.7%). 2. Overweight (BMI ≥ 25 kg/m²) is a risk factor for asymptomatic endometrial thickening after menopause. 3. endometrial thickness ≥ 4 mm is a risk factor to postmenopausal asymptomatic women. 4. The appropriate diagnostic threshold of vaginal ultrasound diagnosis is 5.65 mm in asymptomatic postmenopausal women.

The optimal endometrial thickness threshold for prediction of endometrial cancer in postmenopausal women without bleeding remains uncertain-Systematic review and meta-analysis

The incidental finding of endometrial thickness (ET) >4 mm in the absence of postmenopausal bleeding (PMB) is a common cause of referring women to secondary care. However, there is lack of consensus amongst gynecologists as regards the management. It is estimated that up to 15 % of endometrial cancers occur in women without PMB. The aim this study was to determine the optimal ET threshold, on trans-vaginal ultrasound scan, that discriminates normal endometrium from endometrial hyperplasia and cancer in this cohort. On using a thorough search strategy, a total 16 studies including 4088 women were deemed eligible. However, the data were not amenable to meta-analysis. There were wide variations in the thresholds reported with potential bias given the retrospective nature of the majority of the studies. Despite contacting authors, we could not obtain the primary data to generate a Receiver Operating Characteristic (ROC) Curve. No linear or curvilinear association was found between ET thresholds and the percentage of women diagnosed with endometrial hyperplasia and cancer using either Pearson's correlation, linear or curvilinear regression, or a simple visual scan/scatter diagram. The result of this study reveals the lack of evidence to inform clinical practice in this area, and there is a need for a well-designed multi-center prospective study.

A Review of the Risk Factors Associated with Endometrial Hyperplasia During Perimenopause

Background

Endometrial hyperplasia, characterized by excessive growth leading to endometrial thickening, is commonly observed in the premenopausal period. Its prevalence in postmenopausal women is approximately 15%, peaking between ages 50 and 60. This condition often manifests as abnormal uterine bleeding and can progress to malignancy, with varying risks depending on the type of hyperplasia.

Purpose

This study aims to investigate the factors influencing endometrial thickness during the perimenopausal period and raise awareness among healthcare professionals about the importance of evaluating and caring for individuals with endometrial hyperplasia.

Methods

Studies examining the association between various factors such as diabetes mellitus, hypertension, age, estrogen replacement therapy, anovulatory disorders, smoking, medications, genetic factors, and endocrine-related proteins and the development of endometrial hyperplasia were reviewed. The literature search encompassed relevant databases, including PubMed, Scopus, and Web of Science.

Results

Research findings indicate significant associations between changes in gene expression of several factors and the development of endometrial hyperplasia. Notably, the risk of progression to cancer varies between non-atypical and atypical hyperplasia cases. Factors such as diabetes mellitus, hypertension, age, estrogen replacement therapy, anovulatory disorders, smoking, medications, Lynch syndrome, tamoxifen use, and alterations in gene expression of TNF-α, EGF, IGF-1, IGF-1R, and PTEN have been implicated in the pathogenesis of endometrial hyperplasia.

Conclusion

This study underscores the importance of understanding the factors influencing endometrial thickness during the perimenopausal period. It emphasizes the pivotal role of healthcare professionals in evaluating and caring for individuals with this condition.

Associations between Single Nucleotide Polymorphisms from the Genes of Chemokines and the CXCR2 Chemokine Receptor and an Increased Risk of Endometrial Cancer

Significant relationships with endometrial cancer were demonstrated, both for CCL2, CCL5, and CXCL8 chemokines and for the chemokine receptor CXCR2. The reported case-control study of genetic associations was designed to establish the role of selected single nucleotide polymorphisms (SNPs) of the CCL2, CCL5, CXCL8, and CXCR2 genes in the onset and progression of endometrial cancer. This study was conducted on 282 women, including 132 (46.8%) patients with endometrial cancer and 150 (53.2%) non-cancerous controls. The genotypes for CCL2 rs4586, CCL5 rs2107538 and rs2280789, CXCL8 rs2227532 and -738 T>A, and CXCR2 rs1126580 were determined, using PCR-RFLP assays. The AA homozygotes in CCL5 rs2107538 were associated with more than a quadruple risk of endometrial cancer (p ≤ 0.050). The GA heterozygotes in the CXCR2 SNP were associated with approximately threefold higher cancer risk (p ≤ 0.001). That association also remained significant after certain adjustments, carried out for age, diabetes mellitus, arterial hypertension, or endometrial thickness above 5 mm (p ≤ 0.050). The A-A haplotypes for the CCL5 polymorphisms and T-A-A haplotypes for the CCL2 and CCL5 SNPs were associated with about a twofold risk of endometrial cancer (p ≤ 0.050). In conclusion, CCL2 rs4586, CCL5 rs2107538 and rs2280789, and CXCR2 rs1126580 demonstrated significant associations with an increased risk of endometrial cancer.

Impact of estrogen and progesterone receptor expression on the incidence of endometrial polyps

Aim: We studied the association of estrogen receptor (ER) and progesterone receptor (PR) with endometrial polyp (EP) formation. Methods: A total of 129 EP patients and an equal number of disease-free women were evaluated for ER and PR expression in endometrial tissues. Correlation with EP incidence was analyzed, as well as diagnostic value via receiver operating characteristic curve. Results: ER expression was higher and PR was lower in patients than in controls (p < 0.01). ER levels positively correlated with EP incidence, and PR negatively (p < 0.01). Receiver operating characteristic curves gave ER an area under the curve of 0.6168 (95% CI: 0.5479-0.6856; p < 0.0001) and PR 0.739 (95% CI: 0.6776-0.8003; p < 0.0001). Conclusion: Imbalance in ER and PR expression associates with EPs formation, offering clinical insights into EP pathology.