Objective is to formulate clinical recommendations for the assessment of endometrial thickening when it is found on ultrasound in a postmenopausal patient without bleeding.

Recommendations

• Transvaginal ultrasound should not be used as screening for endometrial cancer.

• Endometrial sampling in a postmenopausal woman without bleeding should not be routinely performed.

• Indications for tissue sampling of the endometrium in bleeding postmenopausal women with an endometrial

• thickness of greater than 4 to 5 mm should not be extrapolated to asymptomatic women.

• A woman who has endometrial thickening and other positive findings on ultrasound, such as increased vascularity, inhomogeneity of endometrium, particulate fluid, or thickened endometrium over 11 mm, should be referred to a gynaecologist for further investigations.

• Decisions about further investigations should be made on a case-by-case basis in asymptomatic women with increased endometrial thickening and risk factors for endometrial cancer such as obesity, hypertension and late menopause.

• In asymptomatic women on tamoxifen, a routine ultrasound for endometrial thickening should not be performed.

• Not all postmenopausal women who have asymptomatic endometrial polyps require surgery.

• Women found to have asymptomatic polyps on ultrasound should be triaged for intervention according to size of the polyp, age, and other risk factors.

• · Ensure that women with asymptomatic thickening and endometrial polyps found on ultrasound are managed appropriately.

• Adoption of these recommendations would save postmenopausal women unnecessary anxiety, pain and risk of procedural complication.

• It is also expected to decrease the cost to the health system by eliminating unnecessary interventions.

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