The complexity of diagnosing endometrial pathology in postmenopausal women using a clinical case example

Pathological processes of the endometrium represent an extensive group of diseases that require special vigilance. In practice, unjustified invasive interventions are often observed in elderly patients, which leads to a search for an approach to routing and treating postmenopausal women undergoing intrauterine interventions.

The purpose of this article is to study the management tactics of postmenopausal patients with endometrial pathology.

Materials and methods. The analysis of data from domestic and foreign literature and guidelines, as well as the medical history of 1 patient, was carried out on the basis of the gynecological department of the CHUZ KB RZD-Medicine Samara.

Results. A patient with a comorbid background and a long postmenopausal period (>15 years) underwent hysteroscopy with suspected uterine polyp, which revealed intrauterine synechiae. After 3 days, according to transvaginal ultrasound, hematometer complications with a suspected fibrin clot were detected.

Conclusions. This clinical case highlights the limited possibilities of ultrasound diagnostics in detecting focal changes in conditions of atrophic endometrium. Management tactics for postmenopausal patients with endometrial pathology should be based on the clinical picture, individual risk, and expediency of intervention. In the absence of symptoms and the presence of small formations, it is possible to choose a wait-and-see approach with regular ultrasound and pipel biopsy, avoiding unnecessary invasive procedures.

1. 1 Clinical recommendations of the Russian Federation "Cancer of the uterine body", 2024.

2. 2 Chernukha GE, Asaturova AV, Ivanov IA, Dumanovskaya MR. The structure of endometrial pathology in various age periods. Obstetrics and gynecology. 2018;8:129-34. (In Russ.) https://dx.doi.org/10.18565/aig.2018.8.129-134

3. 3 Kobaidze EG, Matveeva YuN. Comparison of ultrasound scanning and morphological examination of endometrial polyps in postmenopausal patients. Perm Medical Journal. 2021;38(2):70-78. (In Russ.) https://doi.org/10.17816/pmj38270-78

4. 4 Pereira AEMM, Franco J, Machado FS, Geber S. Accuracy of Transvaginal Ultrasound in the Diagnosis of Intrauterine Lesions. Acurácia da ultrasonografia tranvaginal no diagnóstico de lesões intrauterinas. Rev Bras Ginecol Obstet. 2021;43(7):530-534. https://doi.org/10.1055/s-0041-1732462

5. 5 American Association of Gynecologic Laparoscopists. AAGL practice report: practice guidelines for the diagnosis and management of endometrial polyps. J Minim Invasive Gynecol. 2012;19(1):3-10. https://doi.org/10.1016/j.jmig.2011.09.003

6. 6 Vitale SG, Haimovich S, Laganà AS, et al. Endometrial polyps. An evidence-based diagnosis and management guide. Eur J Obstet Gynecol Reprod Biol. 2021;260:70-77. https://doi.org/10.1016/j.ejogrb.2021.03.017

7. Adamyan LV, Kotova EG, Protasova AE, Pivazyan LG, Papanova EK. Modern operative gynecology in geriatric patients. Russian Journal of Human Reproduction. 2024;30(1):10 25. (In Russ.) https://doi.org/10.17116/repro20243001110

8. 8 Kamolova KD, Parpieva DA, Yuldasheva OS. On the pathogenesis of hyperplastic processes of the endometrium in postmenopause. A young scientist. 2019;249(11):149-151. (In Russ.)

9. 9 Popov AA, Manannikova TN, Alieva AS, Fedorov AA, Bespalova AG. Intrauterine synechia: a century later. breast cancer. Mother and child. 2017;12:895-899. (In Russ.)

10. 10 Bespalova AG, Popov AA, Fedorov AA, Tyurina SS, Koval AA. Intrauterine synechia in the reproductive age: an integrated approach to solving the problem. Russian Bulletin of the obstetrician-gynecologist. 2021;21(2):62 67. (In Russ.) https://doi.org/10.17116/rosakush20212102162