Vaginosonographic measurement of endometrial thickness in the evaluation of amenorrhea

Clinical and biochemical discriminants between functional hypothalamic amenorrhoea (FHA) and polycystic ovary syndrome (PCOS)

“…94 Most (93%, 50/54) amenorrhoeic women with ET > 1.5 mm have a withdrawal bleed, compared with only 6% (1/16) of those with thinner ET. 96 ET is higher in PCOS than controls both on cycle days 3-5 (4.8 vs 3.4 mm) 97 and on days 6-10 (11.1 vs 6.2 mm). 98 ET on a random cycle day is lower in lean amenorrhoeic (n = 43) than oligomenorrhoeic women (n = 18) (5.1 vs 8.2 mm).…”

“…Indeed, endometrial thickness (ET) better predicts the response to progesterone withdrawal than oestradiol level 94 . Most (93%, 50/54) amenorrhoeic women with ET > 1.5 mm have a withdrawal bleed, compared with only 6% (1/16) of those with thinner ET 96 . ET is higher in PCOS than controls both on cycle days 3–5 (4.8 vs 3.4 mm) 97 and on days 6–10 (11.1 vs 6.2 mm) 98 .…”

Evaluation of postmenopausal endometrium

“…Clearly, the expected image of the normal untreated postmenopausal uterus, viewed in mid-sagittal section at an angle of insonation to the uterine axis of between 60 and 90°, includes two very thin basalis layers condensed with the specular reflection of the luminal interface into a regular 'stripe' with a thickness of 4 mm or less. This is actually the clinical correlate of the anatomy of minimally stimulated or absent functionalis in women of any age 14,15 , and correlates well with low total estrogen levels. The term endometrial 'stripe' seems descriptive, but, since it inaccurately suggests that one is dealing with a two-dimensional object, it is probably better to term this structure simply 'endometrium'.…”

Current understanding of hypothalamic amenorrhoea

“…36,37 In women with HA, this variability in endometrial thickness may not be observed and there is evidence to suggest that if the lining is <1.5 mm, the patient is more likely to be hypo-oestrogenic. 38 HA and PCOS are the two most common causes of secondary amenorrhoea, 39 other than pregnancy. Some women with HA may have a coexistent history of symptoms associated with PCOS, such as oligomenorrhoea, hirsutism and acne.…”