From the Guidelines
Asymptomatic women with inhomogeneous endometrium and other positive findings on ultrasound should be managed on a case-by-case basis, with consideration of the potential benefits, risks, and limitations of testing for early endometrial cancer. Inhomogeneous endometrium refers to an irregular or uneven appearance of the uterine lining on ultrasound, which may require further evaluation to determine its cause and appropriate management 1. The management of inhomogeneous endometrium depends on various factors, including the presence of symptoms, underlying medical conditions, and risk factors for endometrial cancer.
Some key points to consider in the management of inhomogeneous endometrium include:
- Women at increased risk for endometrial cancer due to a history of unopposed oestrogen therapy, late menopause, tamoxifen therapy, nulliparity, infertility or failure to ovulate, obesity, diabetes or hypertension should be informed of the risks and symptoms of endometrial cancer and strongly encouraged to report any unexpected bleeding or spotting to their physicians 1.
- Asymptomatic women with risk factors for endometrial cancer who have endometrial thickening and other positive findings on ultrasound, such as increased vascularity, inhomogeneity of the endometrium, particulate fluid or thickened endometrium over 11 mm should be managed on a case-by-case basis 1.
- The potential benefits, risks, and limitations of testing for early endometrial cancer should be explained in order to ensure informed decision making about testing 1.
It is essential to note that the management of inhomogeneous endometrium should be individualized, taking into account the woman's symptoms, medical history, and risk factors for endometrial cancer. A gynecological consultation is recommended for proper assessment and management of inhomogeneous endometrium. Regular follow-up with transvaginal ultrasound is important to monitor changes in the endometrium, especially if abnormal uterine bleeding occurs 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Inhomogenous Endometrium
- The endometrium is a dynamic target organ in a woman's reproductive life, undergoing cyclical changes regulated by the balance between oestrogen and progesterone 2.
- Abnormalities in endometrial thickness (ET) can be assessed using high-resolution transvaginal ultrasonogram, which is the initial best modality for evaluating ET or aberrations 2.
- The cut-off value of ET that warrants investigation is almost defined in post-menopausal women with bleeding, but it is still debated in asymptomatic postmenopausal women and in women on HRT and Tamoxifen 2, 3.
Diagnosis and Evaluation
- Transvaginal ultrasound (TVUS) is an accurate and non-invasive technique for investigating ET in the early diagnosis of endometrial cancer (EC) 3.
- For postmenopausal women with postmenopausal bleeding (PMB), a cut-off of ET ≥4 mm is recommended for office hysteroscopy-guided endometrial sampling 3, 4.
- In postmenopausal women without PMB, arbitrary endometrial sampling is not recommended, but rather evaluated on a case-by-case basis based on risk factors 3.
Risk Factors and Management
- Endometrial cancer (EC) is a risk factor for inhomogenous endometrium, and TVUS can help in early detection 3.
- The immune system plays a role in supporting the viability and growth of ectopic endometriotic tissue, leading to chronic inflammation and pain in endometriosis 5.
- Management options for endometriosis include laparoscopy, hormonal therapy, NSAIDs, dietary changes, exercise, and hysterectomy in severe cases 5.
- Hysteroscopy is the gold standard for evaluating the uterine cavity and diagnosing intrauterine pathology, and can be used for operative intervention in some cases of abnormal uterine bleeding 4.