Transvaginal ultrasonography and endometrial histology in peri- and postmenopausal women on hormone replacement therapy

Br J Obstet Gynaecol. 1999 May;106(5):421-6. doi: 10.1111/j.1471-0528.1999.tb08294.x.


Objective: To determine the association between endometrial thickness and endometrial histology in a large sample of women using HRT.

Design: Results from three multi-centre studies were combined.

Participants: Five hundred and sixty-four climacteric women were treated with either sequential, continuous combined or long-cycle therapy.

Main outcome measures: The women underwent 717 examinations with both transvaginal ultrasonography and histological examination of the endometrium. Endometrial thickness was measured and associated with the histological findings.

Results: Eight cases of endometrial hyperplasia were diagnosed. All the hyperplasias were simple without atypia. Two cases had an endometrial thickness < 4 mm and two a thickness > 8 mm. The > 4 mm threshold for abnormal endometrium had a sensitivity of 75%, a specificity of 47%, a positive predictive value of 2% and a negative predictive value of 99%.

Conclusion: No association could be found between the endometrial thickness measured by transvaginal ultrasonography and endometrial pathology. In six out of eight women with simple hyperplasia the endometrium measured > 4 mm.

Publication types

  • Clinical Trial
  • Multicenter Study

MeSH terms

  • Administration, Cutaneous
  • Endometrial Hyperplasia / diagnostic imaging*
  • Endometrial Hyperplasia / pathology
  • Estradiol / therapeutic use
  • Female
  • Hormone Replacement Therapy / methods*
  • Humans
  • Menopause
  • Middle Aged
  • Norethindrone / therapeutic use
  • Sensitivity and Specificity
  • Ultrasonography


  • Estradiol
  • Norethindrone