Diagnostic evaluation of the endometrium in postmenopausal bleeding: An evidence-based approach

N. Van Hanegem*, M. C. Breijer, K. S. Khan, T. J. Clark, M. P.M. Burger, B. W.J. Mol, A. Timmermans

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

98 Citations (Scopus)


Postmenopausal bleeding (PMB) is a common complaint in general gynecological practice. Women with PMB have around a 10% chance of having endometrial carcinoma and therefore PMB always needs further evaluation. This article summarizes the reviews on the subject and provides an overview of the use of diagnostic tools in patients with PMB. Four types of diagnostic test are described: sonographic measurement of endometrial thickness, endometrial sampling, hysteroscopy and saline infusion sonography. All four have been independently shown to be accurate in excluding endometrial cancer. However, neither in systematic reviews nor in international guidelines is consensus found regarding the sequence in which these methods should be employed in women with PMB. For measurement of endometrial thickness in symptomatic women, a cut-off value of 3 mm is recommended, but the cost-effectiveness of this strategy has yet to be shown. Research should now focus on the incorporation of individual patient characteristics and pre-test probabilities for cancer in algorithms for the investigation of PMB, and the most cost-effective sequenced combination of the four types of test.

Original languageEnglish
Pages (from-to)155-164
Number of pages10
Issue number2
Publication statusPublished - Feb 2011


  • Endometrial biopsy
  • Endometrial carcinoma
  • Endometrial thickness
  • Hysteroscopy
  • Postmenopausal bleeding
  • Saline infusion sonography


Dive into the research topics of 'Diagnostic evaluation of the endometrium in postmenopausal bleeding: An evidence-based approach'. Together they form a unique fingerprint.

Cite this