From January 1, 2020, to October 27, 2023, 173 patients underwent hysteroscopic surgery in our department due to endometrial cells found in cervical cytology. The median age was 50 years (33–82 years). Median BMI was 23.92 kg/m2 (18.07–34.17 kg/m2). The median age of menarche was 14 years (11–19 years). 65 women (37.57%) were postmenopausal. 101 patients (58.38%) had abnormal uterine bleeding/postmenopausal bleeding. 38 women (21.97%) had hypertension. Eight women (4.62%) had diabetes. Three patients (1.73%) had thyroid disease, all with hypothyroidism. The median endometrial thickness was 7.1 mm (1.6–49.9 mm), of which 54 (31.21%) showed uneven echo. 94 patients (54.34%) had normal endometrium, 41 patients (23.70%) had endometrial polyps, 19 patients (10.98%) had endometrial hyperplasia, and seven patients (4.05%) had endometrial atypical hyperplasia/endometrial cancer. (Table 1)
Table 1
Baseline and pathological data of all patients (n = 173)
Variables | Median (range) or n (%) |
Age (years) | 50 (33–82) |
BMI (kg/m2) | 23.92 (18.07–34.17) |
Gravidity | 3 (1–12) |
Parity | 1 (0–4) |
Age of menarche (years) | 14 (11–19) |
Menopause | 65 (37.57%) |
Abnormal uterine bleeding/postmenopausal bleeding | 101 (58.38%) |
Hypertension | 38 (21.97%) |
Diabetes | 8 (4.62%) |
Thyroid disease | 3 (1.73%) |
Endometrial thickness (mm) | 7.1 (1.6–49.9) |
Endometrial echo is not uniform | 54 (31.21%) |
Pathology | |
Endometrial polyp | 41 (23.70%) |
Endometrial hyperplasia | 19 (10.98%) |
Normal endometrium | 94 (54.34%) |
Submucosal uterine fibroid | 5 (2.89%) |
Endometrial atypical hyperplasia/endometrial cancer | 7 (4.05%) |
Endometritis | 7 (4.05%) |
Table 2 shows endometrial thickness in patients with and without abnormal bleeding before and after menopause. 108 were premenopausal women, 71 of them had abnormal uterine bleeding. The median endometrial thickness was 9.5 mm. 37 patients had no abnormal uterine bleeding. Median endometrial thickness was 6.8 mm. 65 patients were postmenopausal, 30 of whom had postmenopausal bleeding. The median endometrial thickness was 5.85 mm. 35 patients had no postmenopausal bleeding, and the median endometrial thickness was 4.0 mm. Both before and after menopause, the endometrial thickness of those with abnormal bleeding was thicker than that of those without abnormal bleeding (premenopausal p = 0.008; postmenopausal p = 0.007).
Table 2
Endometrial thickness in patients with and without abnormal vaginal bleeding before and after menopause (n = 173)
Variables | Endometrial thickness | p-value |
Premenopause (n = 108) | 8.3 (2.0–23.0) | 0.008 |
Abnormal uterine bleeding (n = 71) | 9.5 (2.0–23.0) | |
No abnormal uterine bleeding (n = 37) | 6.8 (2.9–15.5) | |
Postmenopause (n = 65) | 4.6 (1.6–49.9) | 0.007 |
Postmenopausal bleeding (n = 30) | 5.85 (2.0-49.9) | |
No postmenopausal bleeding (n = 35) | 4.0 (1.6–32.0) | |
Five patients (2.89%) had endometrioid cancer, and two patients (1.16%) had endometrial atypical hyperplasia. The median age was 57 years (50–71 years). The median BMI was 22.89 kg/m2 (19.57–29.52 kg/m2). The median age of menarche was 13 years (12–19 years). Five women (71.43%) were postmenopausal. All of them had abnormal uterine bleeding/postmenopausal bleeding. Four women (57.14%) had hypertension. Two women (28.57%) had diabetes. One person (14.29%) had thyroid disease. Endometrial thickness was 22.9 mm and 20.9 mm in 2 premenopausal patients, median endometrial thickness was 34 mm (8.2–41.4 mm) in 5 postmenopausal patients, and heterogeneous endometrial echo in 7 patients. (Table 3)
Table 3
Clinicopathological features of 7 cases of endometrial dysplasia hyperplasia/endometrial cancer (n = 7)
Patient | Age (years) | BMI(kg/m2) | Gravidity | Parity | Age of menarche (years) | Menopause | AUB/PB | Hypertension | Diabetes | Thyroid disease | Endometrial thickness (mm) | Endometrial echo is not uniform | Pathology |
Case 1 | 53 | 22.89 | 4 | 0 | 14 | N | Y | N | N | N | 22.90 | Y | EAH |
Case 2 | 57 | 20.43 | 3 | 1 | 13 | Y | Y | N | N | N | 15.00 | Y | EC |
Case 3 | 50 | 29.52 | 1 | 1 | 12 | N | Y | Y | Y | N | 20.90 | Y | EC |
Case 4 | 59 | 24.65 | 3 | 1 | 19 | Y | Y | Y | N | N | 41.40 | Y | EC |
Case 5 | 51 | 20.02 | 4 | 1 | 12 | Y | Y | N | N | Y | 8.20 | Y | EAH |
Case 6 | 71 | 19.57 | 2 | 2 | 13 | Y | Y | Y | Y | N | 34.00 | Y | EC |
Case 7 | 59 | 24.65 | 3 | 1 | 19 | Y | Y | Y | N | N | 41.10 | Y | EC |
AUB: Abnormal uterine bleeding; PB: Postmenopausal bleeding; Y: Yes; N: No; EAH: Endometrial atypical hyperplasia; EC: Endometrial cancer.
Fifty-four patients had no abnormal uterine bleeding/postmenopausal bleeding, no endometrial thickening, and the endometrial echo was homogeneous. The median age was 51 years (33–81 years). The median BMI was 24.285 kg/m2 (19.14–33.78 kg/m2). The median age of menarche was 14 years (11–17 years). Twenty-two (40.74%) were menopausal. Fourteen people (25.93%) had hypertension. Four people (7.41%) had diabetes. The median endometrial thickness was 4.25 mm (1.6–11.8 mm). Forty-two patients (77.78%) had normal endometrium, eight patients (14.82%) had endometrial polyps, two patients (3.70%) had endometrial hyperplasia, two patients (3.70%) had endometritis, and none had endometrial atypical dysplasia/endometrial cancer. (Table 4)
Table 4
Clinicopathological features of 54 patients with no abnormal uterine bleeding/postmenopausal bleeding and no endometrial thickening (n = 54)
Variables | Median (range) or n (%) |
Age (years) | 51 (33–81) |
BMI (kg/m2) | 24.285 (19.14–33.78) |
Gravidity | 3 (1–11) |
Parity | 1.5 (1–4) |
Age of menarche (years) | 14 (11–17) |
Menopause | 22 (40.74%) |
Hypertension | 14 (25.93%) |
Diabetes | 4 (7.41%) |
Thyroid disease | 0 |
Endometrial thickness (mm) | 4.25 (1.6–11.8) |
Pathology | |
Endometrial polyp | 8 (14.82%) |
Endometrial hyperplasia | 2 (3.70%) |
Normal endometrium | 42 (77.78%) |
Endometritis | 2 (3.70%) |
Univariate logistic regression analysis showed that independent risk factors for endometrial atypical hyperplasia/endometrial cancer included hypertension, diabetes, thyroid disease, endometrial thickness, OR values were 5.176 (1.106–24.235), 10.667 (1.709–66.574), 13.667 (1.083-172.412), and 1.158 (1.078–1.243), respectively. Multivariate logistic regression analysis showed that the independent risk factors of endometrial atypical hyperplasia/endometrial cancer included diabetes and endometrial thickness; OR values were 32.273 (1.340-777.312) and 1.252 (1.070–1.464), respectively. (Table 5)
Table 5
Univariate and multifactorial logistic regression analysis of endometrial atypical hyperplasia/endometrial cancer independent risk factors (n = 173)
Variables | Univariate, p | Univariate, OR | Multivariate, p | Multivariate, OR |
Age | 0.076 | 1.068 (0.993–1.149) | 0.074 | 0.856 (0.723–1.015) |
Menopause | 0.081 | 4.417 (0.831–23.465) | 0.065 | 15.134 (0.846-270.628) |
Hypertension | 0.037 | 5.176 (1.106–24.235) | 0.604 | 0.357 (0.007–17.554) |
Diabetes | 0.011 | 10.667 (1.709–66.574) | 0.032 | 32.273 (1.340-777.312) |
Thyroid disease | 0.043 | 13.667 (1.083-172.412) | 0.094 | 16.258 (0.625-422.983) |
Endometrial thickness | < 0.001 | 1.158 (1.078–1.243) | 0.005 | 1.252 (1.070–1.464) |