To evaluate the value of transvaginal ultrasonography in the assessment of normal and abnormal endometrium in postmenopausal women.

A retrospective analysis of 1779 postmenopausal women who underwent transvaginal ultrasound Capital University of Medical Sciences at Fuxing Hospital from January 2008 to August 2019 was performed, cases without vaginal bleeding and without endometrial lesion were defined as observation group (1630 cases), and the follow-up time was over 1 year. The study group consisted of 149 cases with endometrial lesions and 149 cases with vaginal bleeding in atrophic endometrium The ultrasonographic features, clinical symptoms and pathological results of endometrium were analyzed. The comparison of endometrial thickness at different menopausal time (every 5 years) was performed by independent t test, and the incidence of hydrops was compared between the Observation Group and the study group by 2 test, nonparametric test was used to compare the distribution of endometrial lesions at different ages and different menopausal times (one-way Anova).

In the Observation Group (N=1630) , the normal value of endometrial thickness ranged from 1.7 mm to 4.5 mm, and the measured value of endometrial thickness within 5 years after menopause was larger than that of the population within 6 to 10 years after menopause [(3.28±1.54) mm vs (2.83±1.28) mm], there was significant difference between the two groups (t=4.873, P<0.001), and the endometrial thickness of postmenopausal atrophy was larger than that of normal. The study group included 149 women with endometrial thickness ranging from 1.0 mm to 53.0 mm, and the postmenopausal women with endometrial thickness ≥4 mm and vaginal bleeding had the highest endometrial cancer rate (66.3%, 59/89), the incidence of endometrial polyp was the highest (56.3%). The total incidence of uterine effusion in the observation group was significantly higher than that in the study group [15.3% (249/1630) vs 8.1% (12/149); χ²=5.689, P=0.017]. There was no significant difference in the types of endometrial lesions among different age groups and different menopausal time periods.

Postmenopausal endometrial thickness ≥4 mm with vaginal bleeding is an indication for further clinical examination. Regular transvaginal sonography is the first choice to observe the intimal changes dynamically in asymptomatic postmenopausal women with intimal thickening. Uterine effusion is one of the sonographic manifestations in normal postmenopausal women.