Wednesday, March 30, 2011

Endometrial thickness and DUB

DUB is irregular uterine bleeding due to hormonal imbalance in pre-menopausal women.  Ultrasound is used routinely as a diagnostic modality in DUB. On ultrasound, endometrial thickness is measured, and an increased thickness is quoted regularly as an indication for endometrial biopsy. It 's helpful to evaluate the actual premises of endometrial thickness studies in bleeding disorders.

Endometrial thickness of less than 4 mm in post-menopausal women is very unlikely to be carrying carcinoma, and such a patient, even if she has a few episodes of post-menopausal bleeding, can be safely followed up, without carrying out a D&C. An increased thickness in these women, increases the risk of malignancy upto 10%, and warrants D&C (in post-menopausal woman).

No studies are done which show a correlation between endometrial thickness and carcinoma, in pre-menopausal women, with bleeding disorders. This fact is often forgotten, and increased thickness in women with DUB is used to advice endometrial biopsy. We often forget that in women with infertility, we try to achieve much higher endometrial thickness often giving them estrogens (though benefits of this is not proved). This confusion has gone deep into medical practice and even found its way into literature (unfortunately), like in this site. (The site also mentions PCOD as a cause for ovulatory DUB!)

So, let me make it clear, Ultrasound of endometrial thickness alone, in pre-menopausal women with DUB is not an indication for endometrial evaluation by D&C. 

Then, what's the indication?
As continous estrogen stimulation is the cause for endometrial malignancy, period of DUB (anovulatory, irregular bleeding) more than 6 months can be one. grossly thickened endometrium in ultrasound (not 4 mm but something like 25 mm), irregular endometrium etc are also indication.