Version October 2024
This figure summarizes the approach to evaluation of AUB in patients on tamoxifen when an endometrial biopsy is performed as the initial test. However, TVUS can be used as the first diagnostic step and this approach is summarized separately.
Premenopausal patients with AUB on tamoxifen are managed differently; this is discussed in related UpToDate content.AUB: abnormal uterine bleeding; D&C: dilation and curettage; EC: endometrial carcinoma; SIS: saline infusion sonography; TVUS: transvaginal ultrasound.
* Endometrial biopsy is a "blind" procedure and focal pathology can be missed as less than half of the endometrium is sampled. Thus, the specimen may not be reflective of underlying pathology.
¶ Hysteroscopy with D&C is also reasonable in settings where office hysteroscopy or SIS are not available.
Δ Tamoxifen may result in an unusual ultrasound appearance of the endometrium (eg, endometrial thickening, cystic changes), but further evaluation with endometrial biopsy and hysteroscopy/SIS may demonstrate atrophic endometrium.
◊ Other risk factors for endometrial carcinoma include obesity, early menarche, late menopause, increasing age, Lynch syndrome, and Cowden syndrome.
§ The clinician must decide with the patient regarding whether a particular risk factor is clinically significant and should impact the management decision. Other comorbidities (eg, use of anticoagulation) may also impact this decision.
¥ Patients with bleeding symptoms that persist or recur require further evaluation (eg, hysteroscopy with D&C) regardless of previous evaluations.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
