From the Guidelines
A heterogeneous endometrium requires prompt evaluation by a gynecologist, particularly in postmenopausal women, to determine the underlying cause and appropriate treatment, which may include hormonal therapy, surgical removal of polyps or fibroids, or more extensive procedures if cancer is detected. The heterogeneity may be due to benign conditions such as endometrial polyps, fibroids, adenomyosis, or endometrial hyperplasia, but it can also indicate endometrial cancer, particularly in postmenopausal women 1. For premenopausal women, this finding is often normal during certain phases of the menstrual cycle.
Some key points to consider in the evaluation and management of a heterogeneous endometrium include:
- The importance of a complete assessment, including transvaginal ultrasound and possibly endometrial biopsy, to determine the underlying cause of the heterogeneity 1
- The potential for benign conditions, such as endometrial polyps or fibroids, to cause heterogeneity, and the need for surgical removal if they are symptomatic or cause significant bleeding 1
- The risk of endometrial cancer, particularly in postmenopausal women, and the need for prompt evaluation and treatment if cancer is suspected or diagnosed 1
- The role of hormonal therapy, such as progesterone therapy, in the management of endometrial hyperplasia or early-stage endometrial cancer, particularly in young women who wish to preserve fertility 1
In terms of treatment, the approach will depend on the underlying cause of the heterogeneity and the individual patient's needs and preferences. For postmenopausal women with abnormal bleeding, prompt assessment and treatment are essential to rule out endometrial cancer. For premenopausal women, a more conservative approach may be appropriate, with monitoring through a complete menstrual cycle to determine if the heterogeneity resolves on its own. Ultimately, the goal of treatment is to alleviate symptoms, prevent complications, and improve quality of life, while also addressing any underlying conditions that may be contributing to the heterogeneity.
From the Research
Heterogeneous 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 the endometrium, such as hyperplasia and cancer, can occur due to an imbalance of these hormones.
- Endometrial hyperplasia with atypia is a precancerous condition that can progress to endometrial cancer if left untreated 3, 4.
Risk Factors
- Age and obesity are significant risk factors for endometrial cancer, with younger and more obese patients being more likely to develop the disease 3.
- Postmenopausal women with larger endometrial polyps are also at a higher risk of developing atypical hyperplasia and endometrial cancer 4.
- The use of hormone replacement therapy (HRT) and tamoxifen can also increase the risk of endometrial hyperplasia and cancer 2, 5.
Diagnosis and Treatment
- Transvaginal ultrasonography is the initial best modality for assessing endometrial thickness and detecting abnormalities 2.
- Endometrial biopsy is essential for diagnosing endometrial hyperplasia and cancer, especially in patients with atypical hyperplasia or suspected cancer 3, 6.
- Progestin therapy can be an effective treatment for complex atypical hyperplasia and well-differentiated endometrial carcinoma, especially in patients who are poor surgical candidates or wish to preserve fertility 6.
Endometrial Thickness
- An endometrial thickness of ≥11 mm is associated with a higher risk of endometrial cancer and hyperplasia with atypia in asymptomatic postmenopausal women 5.
- The risk of endometrial cancer and/or endometrial hyperplasia with atypia is 2.6 times greater in women with an endometrial thickness of ≥11 mm compared to those with an endometrial thickness of 5-10 mm 5.