Department of Obstetrics and Gynecology and Women's Health Montefiore Medical Center, Albert Einstein College of Medicine, 3332 Rochambeau Avenue, Bronx, NY, 10467-2836, USA.
Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
Arch Gynecol Obstet. 2022 Sep;306(3):579-583. doi: 10.1007/s00404-022-06540-1.
We evaluated the interpretation of atrophic endometrium (AE) histology as the most common cause for postmenopausal bleeding (PMB). This theory has been accepted for several generations by gynecologists and gynecologic oncologists and has been published in past and current major gynecology textbooks. In our review of the literature, we did not find sufficient histological or clinical proof for this concept. In our view, AE is not a cause of PMB and we back this up with a review of old and current medical literature. The old studies are based on information which was obtained prior to the existence of transvaginal sonogram, sonohysterogram and hysteroscopy. Focal lesions are notorious for being missed by endometrial sampling and curettage. Recent studies show that focal endometrial lesions are a crucial cause for PMB and some of those lesions can harbor cancer. In our opinion, AE is the most common histology found because it is physiologic and a ubiquitous finding in postmenopausal women, but it is not a cause of PMB. Referring to AE as a cause of PMB may result in misdiagnosis of cancer, management delay and unnecessary intervention. To avoid misdiagnosis of cancer, transvaginal sonogram should be considered in all women with PMB and AE on pathology. If endometrial thickness is found, AE is unlikely to be the cause of the PMB and further workup is warranted to reveal the true etiology for the bleeding.
我们评估了萎缩性子宫内膜（AE）组织学作为绝经后出血（PMB）最常见原因的解释。这一理论已经被几代妇科医生和妇科肿瘤学家所接受，并在过去和现在的主要妇科教科书中都有发表。在我们对文献的回顾中，我们没有找到足够的组织学或临床证据来支持这一概念。在我们看来，AE 不是 PMB 的原因，我们通过对旧的和当前的医学文献的回顾来支持这一观点。旧的研究是基于在阴道超声、超声子宫内膜造影和宫腔镜出现之前获得的信息。局灶性病变因子宫内膜取样和刮宫而被漏诊是众所周知的。最近的研究表明，局灶性子宫内膜病变是 PMB 的一个关键原因，其中一些病变可能隐藏着癌症。在我们看来，AE 是最常见的组织学发现，因为它是生理性的，也是绝经后妇女普遍存在的现象，但它不是 PMB 的原因。将 AE 称为 PMB 的原因可能导致癌症的误诊、治疗延误和不必要的干预。为了避免癌症的误诊，所有 PMB 和 AE 患者都应考虑进行阴道超声检查。如果发现子宫内膜增厚，AE 不太可能是 PMB 的原因，需要进一步检查以揭示出血的真正病因。
