New York University School of Medicine, New York, NY 10016, USA.
Menopause. 2011 Apr;18(4):434-6. doi: 10.1097/gme.0b013e31820ad00b.
Postmenopausal bleeding is "cancer until proven otherwise." A thin distinct endometrial echo on transvaginal ultrasound has a risk of malignancy of 1 in 917 and does not require an endometrial biopsy. If the endometrial echo is poorly visualized, then in such women, saline infusion sonohysterography is an appropriate next step. The prevalence of asymptomatic endometrial thickening (mostly due to inactive polyps) is high, approximately 10% to 17% of postmenopausal women. The risk of malignancy in such polyps is low (approximately 0.1%), and in structures that mimic polyps, it is also low (0.3%). The incidence of serious complications from an operative intervention in such postmenopausal women is not insignificant (1.3%-3.6%). Thus, automatic intervention in such women, without any high-risk status, is not warranted.
绝经后出血是“癌，除非另有证明”。经阴道超声显示子宫内膜回声薄而清晰，其恶性风险为 1/917，不需要进行子宫内膜活检。如果子宫内膜回声显示不佳，则在这些女性中，生理盐水灌注超声检查是下一步的合适选择。无症状性子宫内膜增厚（主要是由于无活性息肉）的患病率较高，约为 10%至 17%的绝经后妇女。这些息肉的恶性风险较低（约 0.1%），而类似息肉的结构的恶性风险也较低（0.3%）。在这些绝经后妇女中，手术干预的严重并发症发生率并不低（1.3%-3.6%）。因此，对于没有高危状态的此类妇女，不应自动进行干预。
