SAN ANTONIO — Increased endometrial thickness on ultrasound is a strong risk factor for endometrial hyperplasia in adolescent and young women with prolonged, irregular menstrual bleeding.
“There are very scarce data on adolescent women,” Dr. Mee Hwa Lee said. So she and her colleagues retrospectively studied 54 patients (aged 13–20 years) with irregular menstrual bleeding. They each had an endometrial biopsy between 1999 and 2007.
A total of 16 patients (30%) had endometrial hyperplasia (EH) based on endometrial sampling. “Endometrial hyperplasia is not an uncommon condition in adolescent girl patients with irregular menstrual bleeding,” Dr. Lee said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.
Another 30 patients had normal endometrium and 8 had a polyp detected.
Dr. Lee and her associates found three risk factors associated with a significantly higher risk of EH in this population: endometrial thickness of 12 mm or greater (odds ratio, 37.3) and endometrial thickness of 14 mm or greater (OR, 35.0) on ultrasound, and prolonged vaginal bleeding (OR, 4.33).
“Ultrasonography seems to be an effective test,” Dr. Lee said.
An endometrial thickness of 12 mm or greater was the most sensitive risk factor (sensitivity of 94%, specificity of 84%, positive predictive value of 71%, and negative predictive value of 97%).
A combination of this feature with an abnormal ultrasound endometrial appearance increased the specificity to 97% (but sensitivity is 44%, positive predictive value is 87%, and negative predictive value is 80%).
“The thickness cutoff value of 12 mm is the most reliable for adolescent endometrial hyperplasia,” said Dr. Lee of the department of obstetrics and gynecology, Pundang CHA General Hospital, Pochon CHA University, Gyeonggi do, Korea.
“Endometrial hyperplasia could be ruled out if the endometrial thickness is less than 10 mm,” she added.
In contrast, body mass index of 25 kg/m
The researchers also looked for clinical risk factors significantly associated with EH. A univariate analysis identified prolonged vaginal bleeding (OR, 4.3), but the significance disappeared on multivariate analysis, Dr. Lee said. “No clinical risk factor assessed in this study showed significance in predicting EH in adolescent patients with irregular menstrual bleeding.”
Physicians recommend an endometrial biopsy for most but not all patients with irregular menstrual bleeding at her institution, Dr. Lee said in response to a question from an attendee. This study supports examination with less invasive ultrasound—it is “not about doing an endometrial biopsy in all patients, but [about] the high proportion of endometrial hyperplasia in this age group,” she noted.
One limitation of the study was its retrospective design, Dr. Lee said. For example, the incidence of EH might be different in a prospective, randomized trial, she said.
Endometrial hyperplasia is not uncommon in adolescent girls with irregular menstrual bleeding. DR. LEE