The Importance of Endometrial Fluid Collection in Postmenopause

Abstract

Objective: We sought to determine the importance of postmenopausal endometrial fluid collection, which has almost invariably been accepted as a finding of a malignant process. Methods: Out of 1,500 postmenopausal patients admitted to our center mainly for their postmenopausal symptoms, endometrial fluid collection was detected in 15 cases during transvaginal pelvic ultrasonographic evaluations. These patients were evaluated with cervical smears as well as endocervical and endometrial curretages. The fluid collections were aspirated and measured. Results: The mean age and mean menopausal age were 51.7 ± 1.3 and 5.7 ± 9.8 years, respectively. Six of the patients were already on hormone replacement therapy. Nine were asymptomatic and the others had vaginal discharge and pelvic pain. Ten patients had normal findings on pelvic examination, and in the others benign cervical polyps, previous cervical amputation, cervical erosion, and nabothian cysts were detected. The volume of the directly measured fluid was 7.9 ± 4.0 cm3. The cervical smears, the cytological examinations of the fluids, the colposcopic examinations and the endocervical curretages were negative, and the histopathological evaluation of the endometrial curretage specimens revealed no premalignant or malignant disease, but blood and fibrin in 1 patient, inactive endometria in 9 patients, proliferative endometria in 4 patients and senile cystic atrophy in 1 patient. Conclusion: Although there was no malignancy in our series, the conflicting results of the limited number of studies made us cautious and we still consider that postmenopausal patients with endometrial fluid collection may be at risk for gynecologic cancers and that every effort should be made in order to rule out such a condition.

Endometrial fluid in postmenopausal women

“…Different frequencies of intrauterine fluid accumulation, ranging from 1% to 14%, have been reported previously [4,5]. In the present retrospective analysis, endometrial fluid was present in 3.1% of asymptomatic postmenopausal women who were not undergoing hormonal therapy.…”

“…Fluid accumulation in the endometrial cavity is an important finding because it may suggest endometrial pathology, including endometrial cancer [1]. However, studies into the frequency and significance of accumulated endometrial fluid are conflicting [1–6]. Although some reports have included women undergoing postmenopausal hormone replacement therapy, information is limited regarding associated clinical problems such as hypertension and diabetes [2].…”

Echogenic Endometrial Fluid Collection in Postmenopausal Women Is a Significant Risk Factor for Disease

“…[5][6][7] However, other investigators reported a low incidence of significant endometrial disease in postmenopausal women with endometrial fluid collection. 2,[8][9][10] Cervical stenosis has been suggested as a cause of endometrial fluid collection because it prevents the physiologic drainage of the uterine cavity. 12 In addition, Goldstein 8 proposed that postmenopausal endometrial fluid collection is a transudate attributable to cervical stenosis.…”

“…collection. 2,[8][9][10] These investigators concluded that postmenopausal intrauterine fluid collection is a common, benign finding and may be the result of the naturally happening atrophic process. 3,8,11 Goldstein 8 proposed that postmenopausal fluid collection is a transudate attributable to cervical stenosis.…”

US of the Nongravid Cervix with Multimodality Imaging Correlation: Normal Appearance, Pathologic Conditions, and Diagnostic Pitfalls

“…Although US cannot be used to directly measure the diameter of the region of luminal narrowing, stenosis can be inferred by persistent fluid in the endocervical canal (Fig 9) or uterine cavity. Although a small amount of fluid or mucus in the endocervical canal may be normal in women of menstruating age (10), a large amount of endocervical and endometrial fluid distending the canal, particularly if the fluid is complex, should prompt a careful search for potentially associated endometrial or cervical mass lesions because this finding may signal an underlying malignancy (52)(53)(54). If the fluid in the endocervical canal is complex, its heterogeneous echogenicity at US may mimic a solid lesion (Fig 9); however, the absence of detectable flow at color Doppler US and the central location should suggest the correct diagnosis.…”