Endometrial pathology in the postmenopausal woman – an evidence based approach to management TOG 2014

Question 1

How common are endometrial polyps in pre and post menopausal and women on tamoxifen?

Answer 1

Pre: 5.8%
Post: 12%
Tamoxifen 30-60%

Question 2

Causes of PMB - %?
Polyps
Endometrial Hyperplasia
Endometrial carcinoma
Exogenous oestrogen’s
Atrophic

Answer 2

Polyps 2-12%
Endometrial Hyperplasia 5-10%
Endometrial carcinoma 10%
Exogenous oestrogen’s 15-25%
Atrophic 60-80%

Question 3

Risk of atypic and malignancy with polyps

Answer 3

Atypia 0.8%
Malignancy 3%

Question 4

Management of polyps

Answer 4

If symptomatic - remove
If asymptomatic - unclear, higher risk perforation, mostly removed

Question 5

What is the risk of of hyperplasia becoming cancer
- Atypia
- No atypa (simplex and complex)

Answer 5

• Atypia - 30%
• No atypia <5% (1% simple, 4% complex)

Question 6

Table explaining the difference between Type 1 and Type 2 endometrial cancer
- Unopposed oestrogen
- Menopausal status
- Precursor lesion
- Tumour grade
- Myometrial invasion
- Histological type
- Behaviour
- Genetic factors

Answer 6

Question 7

With tamoxifen use - how much does the endometrial thickness increase each year? After stopping how much does it decrease per year?

Answer 7

0.75mm per year, 12mm after 5 years

After stopping 1.27mm per year

Question 8

What proportion of women taking tamoxifen have ET >5mm within 1 year of use?

Answer 8

80%