Assessment and Diagnostic Findings
Annual Checkups:
It's important for all women to have yearly checkups, which include a gynecologic examination. This
helps with the early detection of any potential issues
o Early Detection: To identify potential health issues before they become serious.
o Preventive Care: To maintain overall health and prevent diseases.
o Monitoring: To keep track of any existing health conditions and manage them effectively.
Endometrial aspiration or biopsy
is often performed to rule out hyperplasia, which can be a precursor to endometrial cancer. This
procedure is quick and usually not painful.
Endometrial hyperplasia is a condition where the endometrium (the lining of the uterus) becomes
excessively thick. This thickening is usually due to an imbalance of hormones, particularly an excess
of estrogen without enough progesterone
Procedure:
1. Preparation: You'll be asked to undress from the waist down and lie on an exam table with your feet in
stirrups. A speculum is inserted into the vagina to hold it open1.
2. Cervix Cleaning: The cervix and vagina are cleaned with an antiseptic solution.
3. Insertion of the Biopsy Device: A thin, flexible tube called a pipelle is inserted through the cervix into the
uterus. The doctor gently moves the pipelle to the upper part of the uterus and uses suction to collect a
small sample of endometrial tissue1.
4. Tissue Collection: The tissue sample is then removed through the tube and sent to a lab for analysis.
5. Completion: The entire procedure usually takes about 10-15 minutes. You might experience some
cramping or discomfort during and after the biopsy, but it is generally well-tolerated1.
Diagnostic Use in Uterine Cancer:
Early Detection: An endometrial biopsy is often used to diagnose endometrial cancer by examining
tissue samples for abnormal or cancerous cells.
Symptom Evaluation: It helps in diagnosing the cause of abnormal uterine bleeding, such as
postmenopausal bleeding or irregular menstrual cycles.
Monitoring: It can be used to monitor the effectiveness of treatments for endometrial conditions
Findings:
Abnormal Cells: The biopsy can reveal the presence of abnormal or cancerous cells in the endometrial
tissue.
Endometrial Hyperplasia: This condition involves the thickening of the endometrium and can be a
precursor to cancer.
Cancerous Tumors: Identification of malignant tumors within the endometrial lining.
Precancerous Changes: Detection of changes in the cells that may indicate a risk of developing cancer
Transvaginal Ultrasound:
This imaging test measures the thickness of the endometrium (the lining of the uterus). In
postmenopausal women, the endometrium should be very thin due to low estrogen levels. If its
thicker, further investigation is needed.
o transvaginal ultrasound (measure thickness of endometrium); a thin endometrium (under
4mm) is normal in postmenopausal women. If it is thicker than normal, a hysteroscopy
and biopsy is undertaken
o Premenopausal Women: During menstruation, the endometrial thickness is typically 2-
4 mm. It increases to 5-7 mm in the early proliferative phase (days 6-7), 11 mm in the
late proliferative phase (days 11-14), and 7-16 mm in the secretory phase (days 14-28).
o Postmenopausal Women: The normal endometrial thickness is usually less than 5
mm. However, in women on hormone therapy, it can reach up to 15 mm.
Endometrial Thickness
1. Premenopausal Women:
o Normal Variation: Endometrial thickness varies throughout the menstrual cycle. During
menstruation, it's thin (2-4 mm), but it thickens as the cycle progresses, reaching up to
16 mm in the secretory phase.
o Reproductive Health: A thicker endometrium can be beneficial for implantation during
the reproductive years.
2. Postmenopausal Women:
o Normal Thickness: Should be less than 5 mm. A thicker endometrium in
postmenopausal women can indicate abnormal changes.
o Concerns: A thicker endometrium can be a sign of conditions such as endometrial
hyperplasia or endometrial cancer.
When to Be Concerned:
Postmenopausal Women: If the endometrial thickness exceeds 5 mm, it warrants further
investigation to rule out potential issues like hyperplasia or cancer.
Irregular Bleeding: Any abnormal bleeding combined with increased endometrial thickness
should be evaluated promptly.
Key Takeaway:
Premenopausal: Variation in thickness is normal and necessary for reproductive health.
Postmenopausal: A thin endometrium is normal; thicker than 5 mm requires further
investigation.
Procedure:
1. Preparation: You'll be asked to undress from the waist down and lie on an exam table with your feet in
stirrups. A speculum is inserted into the vagina to hold it open2.
2. Transducer Insertion: A small, wand-like device called a transducer, covered with a sterile cover and
lubricating gel, is gently inserted into the vagina.
3. Imaging: The transducer emits high-frequency sound waves to create detailed images of the pelvic
organs, including the uterus, ovaries, fallopian tubes, and cervix.
4. Duration: The procedure typically takes about 15-30 minutes.
Findings Related to Uterine Cancer:
Endometrial Thickness: A thickness of 4 mm or less has a high negative predictive value for
endometrial cancer.
Abnormal Growths: Identification of masses, tumors, or thickening of the endometrial lining, which may
indicate cancer.
Further Testing: If abnormalities are detected, a biopsy may be recommended to confirm the presence
of cancerous cells
Hysteroscopy and Biopsy:
If the ultrasound results are abnormal, a hysteroscopy is performed. This procedure involves inserting
a thin, lighted tube (hysteroscope) through the vagina and cervix into the uterus to visually examine
the uterine lining. During this procedure, a biopsy (removal of a small tissue sample) is often
conducted to check for cancerous cells
o Purpose: Performed if ultrasound results are abnormal.
o Procedure:
i. Hysteroscopy: Involves inserting a thin, lighted tube (hysteroscope) through the
vagina and cervix into the uterus to visually examine the uterine lining.
ii. Biopsy: Removal of a small tissue sample during hysteroscopy to check for
cancerous cells.
o Importance: Helps in diagnosing and confirming the presence of cancerous cells in the
uterine lining.
Procedure:
1. Preparation: You'll be asked to undress from the waist down and lie on an exam table with your feet in
stirrups. A speculum is inserted into the vagina to hold it open.
2. Cervix Cleaning: The cervix and vagina are cleaned with an antiseptic solution.
3. Hysteroscope Insertion: A thin, lighted tube called a hysteroscope is inserted through the cervix into
the uterus. The hysteroscope allows the doctor to see inside the uterus.
4. Saline Solution: A small amount of saline solutions are injected through the hysteroscope to expand the
uterine cavity and improve visibility.
5. Biopsy: If any abnormalities are detected, a biopsy may be performed during the procedure. This
involves taking small tissue samples from the uterine lining for further examination.
6. Completion: The entire procedure usually takes about 20-30 minutes. You might experience some
cramping or discomfort during and after the procedure, but it is generally well-tolerated.
Findings Related to Uterine Cancer:
Abnormal Growths: Identification of polyps, fibroids, or other abnormal growths in the uterine lining.
Endometrial Hyperplasia: Thickening of the endometrial lining, which can be a precursor to cancer.
Cancerous Tumors: Detection of malignant tumors within the endometrial lining.
Precancerous Changes: Identification of changes in the cells that may indicate a risk of developing
cancer
Biopsy or Aspiration:
These procedures involve taking a small sample of tissue from the endometrium to check for
abnormalities. This is a key diagnostic step to identify potential issues.
Procedure:
1. Preparation: You'll be asked to undress from the waist down and lie on an exam table with your feet in
stirrups. A speculum is inserted into the vagina to hold it open.
2. Cervix Cleaning: The cervix and vagina are cleaned with an antiseptic solution.
3. Insertion of the Biopsy Device: A thin, flexible tube called a pipelle is inserted through the cervix into
the uterus. The doctor gently moves the pipelle to the upper part of the uterus and uses suction to collect
a small sample of endometrial tissue1.
4. Tissue Collection: The tissue sample is then removed through the tube and sent to a lab for analysis.
5. Completion: The entire procedure usually takes about 10-15 minutes. You might experience some
cramping or discomfort during and after the biopsy, but it is generally well-tolerated1.
Findings Related to Uterine Cancer:
Abnormal Cells: The biopsy can reveal the presence of abnormal or cancerous cells in the endometrial
tissue.
Endometrial Hyperplasia: This condition involves the thickening of the endometrium and can be a
precursor to cancer.
Cancerous Tumors: Identification of malignant tumors within the endometrial lining.
Precancerous Changes: Detection of changes in the cells that may indicate a risk of developing cancer
transvaginal ultrasound and endometrial biopsy are the gold standard test
References:
American College of Obstetricians and Gynecologists. (2015). Practice Bulletin No. 149: Endometrial
cancer. Obstetrics and Gynecology, 125(4), 1006–1026.
Beckmann, C. R. B., Ling, F. W., Smith, R. P., Barzansky, B. M., Herbert, W. N. P., Laube, D. W., & Smith,
R. P. (2014). Obstetrics and Gynecology. Lippincott Williams & Wilkins.
Hinkle, J. L., & Cheever, K. H. (Eds.). (2018). Brunner & Suddarth's Textbook of Medical-Surgical
Nursing (14th ed.). Wolters Kluwer.
Ignatavicius, D. D., & Workman, M. L. (2015). Medical-Surgical Nursing: Patient-Centered Collaborative
Care (8th ed.). Elsevier.
